The long-awaited Jupiter trial was released today and the data was compelling, with internist (and study participant) Matthew Mintz saying “it will likely change guidelines.” Robert Centor called it “remarkable.“
Patients with a normal cholesterol, normal risk of heart attacks, but an elevated C-reactive protein, were given 20mg of Crestor. There was a 44 percent reduction in death and cardiovascular events over 1.9 years.
Dr. Mintz provides an excellent interpretation of the results, commenting on the safety profile of Crestor, if treating CRPs alone was beneficial, and whether you could substitute Crestor with a generic statin like simvastatin.
Here’s his bottom line:
The anti-statin, anti-pharma folks will try to shoot this one down, but the data is pretty solid. If you are a man over 50 or a woman over 60, you should definitely ask your doctor to check your CRP if you cholesterol is relatively normal, and you would not otherwise be a candidate for cholesterol lowering medication. If your CRP is elevated, I think Crestor 20mg is a good option, since it is not clear that other medications (specifically simvastatin) would provide similar benefit.
Jaan Sidorov predicts an explosion in statin use, especially “among persons that would not have otherwise qualified for treatment.”
On the other hand, Merrill Goozner is skeptical, asking whether CRPs and Crestor will be the next chapter in medical waste:
The first thing you need to know about this trial is that its lead investigator, Paul Ridker of Brigham and Women’s Hospital in Boston, owns patents on the $20 test that measures CRP, and that the trial was funded by AstraZeneca, whose $3.45-per-day or $1,250-per-year statin (rosuvastatin or Crestor), was used in the test.
Update 11/10 -
Cardiologist Dr. Wes:
“If we assume that a 20-mg daily rosuvastatin (Crestor) tablet costs $107 per month to treat the average patient, and that twenty five patients have to be treated for five years to prevent one cardiovascular complication (and this does not include the annual liver function tests, the cholesterol tests, the C-reactive protein checks, etc), we begin to focus on an inevitable realization: that prevention is a remarkably expensive way to deal with our exploding health care costs.”
Maggie Mahar:
“Here is the question you have to ask yourself: would you want to take this drug for the rest of your life based on the possibility that you might be the 1 out of 120 who benefits? It depends.
First, it depends on how you feel about the side effects. The patients who took Crestor showed “significantly higher glycated hemoglobin levels and incidence of diabetes,” Hlatky points out (3.0%, vs. 2.4% in the placebo group). Translation: There were 270 cases of diabetes among patients who took Crestor compared with 216 among those on placebo.”
Update 11/13 -
Cardiologist DrRich has the most thorough analysis I’ve read thus far.
topics: statins, crp
Related posts:
- Should you stop taking Vytorin if you’re already on the drug?
- Statin box office
- Brewer: Falling HDLs due to generic statins?
- Why you should stop taking Vytorin for high cholesterol
- Vytorin continues to take hits
- Why doctors should reconsider ordering a CRP to screen patients for heart disease
- Is a lower cholesterol or A1c necessarily better?
{ 5 comments }
Sure I think it would be wise. There have also been epidemiological studies that showed those on statins had a reduced risk of prostate and breast cancer. Statins inhibit the mevalonate pathway which means more than cholesterol synthesis. Part of that pathway is responsible for prenylation which activates cell signalling proteins such as Ras and Rho. These proteins are involved in mediating the effect of inflammatory cytokines such as Il-8 and CRP. Although the makers of Crestor are going to make a big deal about this effect being specific for Crestor, all statins inhibit the mevalonate pathway so, generic statins should work just as well and are much more affordable. Please see my blog at http://www.takingcontrolofyourhealthcare.com.
Other than Evil Pharma, what other sources of funding are made available for these studies? Just asking …
There have also been epidemiological studies that showed those on statins had a reduced risk of prostate and breast cancer
None of these studies were conclusive…. Before these studies were those that showed increased risk, than there were those that showed no effect.
Before you tell about possible cancer benefit to your patients, maybe you should wait for some real evidence like RCTs? There have been plenty of observational studies that showed benefits of HRT too.
Dr. K. – reading your posts I sometimes wonder if you even understand the difference between relative risk and absolute risk.
“120 participants were treated for 1.9 years to prevent one event.”
So if I were in this group and I were to take a statin, it’ll translate in about 1/120 chance in 1.9 years of benefitting me. What are the chances of my experiencing a side effect that would affect my quality of life as a result? Are they really that much smaller than this?
I wonder, when you talk to your patients do you also use this totally meaningless relative risk reduction numbers? Or do you explain absolute chance of them benefiting?
I think this is vastly oversold. NNT 120. Not with a risk of developing diabetes near that. Statins have side effects. The issue of the spike in premature deaths in statin patients has never been clarified. I think that the way this is being spun is just a great big drug ad. How many patients would really accept this given the NNT, fully apprised of the side effect (and the fact that they may not all be known), and paying with their own money? Not many I bet.
Perhaps I am biased. Been there, done that with the statin thing. Nearly killed me. I am sure that I am not the only one. Having a heart attack would be better than the slow brain rot I had from the statin.
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