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Study Suggests a Wider Use for Statins

Drugs could help those who only have high levels of inflammation, experts say

TUESDAY, Sept. 22 (HealthDay News) -- Statins could be as beneficial for people with acceptable cholesterol readings but high levels of inflammation as they are for those with high cholesterol levels, a new analysis finds.

An earlier study of more than 17,000 participants, known as the JUPITER trial, found that rosuvastatin (Crestor) cut the risk for serious vascular problems in people whose cholesterol levels were not high while high-sensitivity C-reactive protein (hs-CRP) levels were.

CRP is a protein that increases during whole-body inflammation, and testing its levels has become an additional way to assess the risk of cardiovascular disease.

"The JUPITER trial demonstrated that rosuvastatin, when given to apparently healthy men and women with low cholesterol but increased hs-CRP, reduced heart attack by 55 percent, stroke by 48 percent, angioplasty and bypass surgery by 46 percent and all-cause mortality by 20 percent -- all highly significant -- and did so in the absence of major side effects," said Dr. Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston and a member of the JUPITER Study Group. He is the lead author of the new analysis, which is published online Sept. 22 and in the November issue of Circulation: Cardiology Quality and Outcomes.

The new analysis takes the study results a step further, attempting to interpret them in practical terms -- to evaluate whether the absolute risk reduction justifies wider prescribing of the statins.

Ridker and his colleagues calculated the absolute risk reduction and also used an epidemiological measure called "number needed to treat." That measure looks at the number of people who would need to be treated to prevent one additional bad outcome.

The JUPITER participants all had acceptable LDL cholesterol (below 130 milligrams per deciliter) but an hs-CRP of 2 milligrams/liter or higher. According to the American Heart Association, an hs-CRP of less than 1 reflects a low risk of getting cardiovascular disease.

The researchers found that "the efficiency of treating elevated hs-CRP patients with statins is at least as good, if not better, than the efficiency of treating those with high cholesterol," Ridker said.

The new analysis, he said, is expected to help clarify future guidelines about who should and should not be on statins.

JUPITER was funded by AstraZeneca, which makes Crestor.

And though the analysis was meant to help physicians and policymakers, it does have a take-home message for patients, one expert said.

It suggests there is a much broader population that may benefit from statins, said Dr. Gregg Fonarow, a cardiologist and professor of medicine at the University of California, Los Angeles. "Those who tend to be treated those who have very high cholesterol."

Also, he said, some doctors test their patients who at risk for cardiovascular disease for CRP levels, but other do not. "You might want to ask your doctor if you should have a CRP test," Fonarow said.

To assess cardiovascular risk, a doctor takes many factors into account, including age, blood pressure, cholesterol and family history -- and the use of statins doesn't negate the need for paying attention to lifestyle issues, Ridker and Fonarow agreed. They stressed the need to maintain a healthy weight and healthy cholesterol levels, to exercise regularly and to not smoke, or to stop if you do.

And not everyone should take statins, Fonarow added. People with active liver disease, for instance, should not be on the medications, he said, nor should those who have had an adverse reaction to them.

More information

The American Heart Association has more on C-reactive protein.

SOURCES: Paul M. Ridker, M.D., director, Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston; Gregg C. Fonarow, M.D., professor, cardiology, David Geffen School of Medicine, University of California, Los Angeles; Sept. 22, 2009, Circulation: Cardiovascular Quality and Outcomes, online

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