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
