A few years ago, with my LDL cholesterol pushing 125, I decided to start myself on Lipitor with the approval of my own internist. Despite the fact that my father has heart disease, I knew that I was in the category of patients where there were no clearcut guidelines. In fact I knew at the time that most cardiologists would probably say that I was jumping the gun and erring on the side of overtreating. But the latest research would suggest that I was probably right.
As most of my readers know by now, a new landmark study just published in the New England Journal of Medicine, Known as JUPITER, looked at more than 17,000 healthy men and women at multiple centers in the U.S. and Europe with normal cholesterols (LDL less than 130 mg/dl) but with elevated C-Reactive Protein levels. Many scientists believe that high levels of this protein correlates with a high risk of heart disease, though there is by no means a consensus on this.
Previous studies who shown that patients with multiple cardiac risk factors have less heart attacks and strokes when taking a statin drug, but this is the FIRST large study in people with relatively normal cholesterol where taking a statin dramatically affected outcome.
The JUPITER trial was stopped after 2 years because the results were so dramatic - there were half as many heart attacks and almost half as many strokes and unstable angina in the group which received Rosuvastatin (Crestor). I'm sure that these results will lead more doctors to prescribe more statin drugs, expecially Crestor. But the real question is, who should receive the drug and who shouldn't? Detractors of the study will point out that Astra Zeneca, which makes Crestor, was a sponsor of the study and that it was only two years long. But this doesn't take away from the dramatic results.
Patients and their doctors who have previously been very conscious of muscle aches that they ascribe to the drug, or are now aware of the possible slight increase risk of diabetes that the study detected, will still have to consider the fact that Crestor and likely other statin drugs appear to dramatically decrease cardiac risk. Here is my take_
* I will have a much lower threshold for prescribing statin drugs, especially in patients older than 50. (the study looked at men in their 50s and women in their 60s). * I will be more inclined to prescribe statins for primary prevention (patients who have no known heart disease) on the basis of cardiac risk factors (family history, smoking, high blood pressure, etc) even when their cholesterol is only mildly elevated (LDL cholesterol between 110 and 130). * I will follow CRP levels in patients over 50 years old, especially in those with cardiac risk factors, but I continue to reserve judgment on the specific significance of these results. * I will continue to emphasize diet modification, stress reduction, and increased exercise as mainstays of primary prevention of heart disease. * I will be glad to see further longer studies on statins, though I recognize the importance of JUPITER.
Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of "False Alarm: the Truth About the Epidemic of Fear" and "Bird Flu: Everything You Need to Know About the Next Pandemic". Read more at www.doctorsiegel.com
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