Consumer Reports Medical Adviser Says ‘Not So Fast’
on Statins for Everyone
Consumer Reports' chief medical adviser blogs
about recent study showing a cholesterol lowering drug - Crestor - cut
the risk of heart attack and stroke, even in people with normal
cholesterol.
By Dr. Marvin Lipman,
Consumer Reports
Blog has video
interview with Dr. Lipman (see link at bottom of page)
Nov. 18, 2008 - I started getting phone calls from
my patients almost as soon as the headlines starting appearing last
week. All the media were trumpeting the results of a new study showing
that rosuvastatin (Crestor), a powerful cholesterol-lowering statin
drug, slashed the risk of heart attack and stroke even in people with
normal—that’s right, normal— cholesterol levels who also had high blood
levels of a substance called C-reactive protein. CRP rises when the
arteries are inflamed, and, as we’ve previously reported, growing
research has linked such inflammation with an increased risk of heart
attack. All of those callers wanted to know the same thing: Should they
start taking the drug?
Here’s my answer to that and two related questions.
HsCRP is one of the most widely studied markers of
inflammation in cardiovascular disease: statement from the director of
National Heart, Lung, and Blood Institute
Nov. 11, 2008 – A new term that every senior
citizen should remember is “high-sensitivity C-reactive protein (hsCRP).”
This is the new protein indicator of inflammation that can be detected
by a simple blood test and warns of heart disease. The discovery guides
treatment that can significantly lower the risk of heart attack, stroke,
and death. Read
more..
Probably not, at least based on this study. The
trial, released on November 9th by the New England Journal of Medicine,
looked at some 18,000 people with an LDL (bad) cholesterol level less
than 130 milligrams per deciliter and a CRP level over 2 micrograms per
liter. Half got Crestor and half got a placebo. After about 2 years the
study was halted because there were 44 percent fewer cardiovascular
events in one group than in the other. The winner turned out to be the
group that took Crestor.
Sounds impressive, right? Well, maybe not very.
That’s because cardiovascular disease is relatively uncommon in the
group of people enrolled in the study.
So the absolute reduction in the rate of heart
attack, stroke, and cardiovascular death went from about 2 per 100
patients in the placebo group to 1 per 100 in the treatment group. At
that rate, it would take treating 120 people for nearly two years to
prevent one event. A benefit, yes, but is it one that’s worth the
treatment’s costs?
Those costs are both medical and financial. For
example, people in the study who took rosuvastatin showed worrisome
changes in blood-sugar levels that could signal an increased risk of
diabetes.
And, as our Best Buy Drug Report on statins
discusses, all of the drugs can cause muscle aches, soreness, and
tenderness in about 1 to 5 percent of people. And rarely, they can cause
the muscle tissue to break down, which in turn can trigger
life-threatening kidney damage. A year’s costs for the drugs—including
Crestor—can exceed $1,000.
Should I get my CRP level measured?
That depends mostly on your overall risk of
cardiovascular disease. People who are at high risk because they have a
clearly elevated LDL level usually don’t need the test, since they
should be treated with a statin regardless of their CRP.
And I don’t think it’s time to measure CRP in
people with low LDLs and few, if any other coronary risk factors,
because it’s not yet clear that the benefit of treatment for such very
low risk people outweighs the costs and possible harms. But for people
at moderate risk of coronary disease - with a borderline elevated LDL,
for example, and perhaps a few other risk factors - knowing the CRP can
help you decide how aggressively to lower LDL. For more on how to use
your LDL, CRP, and other risk factors to assess your need for
cholesterol-lowering drugs, see our Guide to a Healthy Heart,
click here.
If I do need a statin, does this study mean I
should definitely take rosuvastatin?
No. Other statins—including atorvastatin (Lipitor),
lovastatin (Mevacor and generic), and simvastatin (Zocor and
generic)—also lower both LDL and CRP. And some are much cheaper. For
example, a month’s supply of Crestor costs, on average, about $105. But
you can get a month’s supply of generic simvastatin for around $30 at
many retail pharmacies or even as low as $6 at Costco.
For more on how to treat high cholesterol, check
out our Treatment Rating,
click here.
>> Go to Dr. Lipman’s Blog for updates and
comments. It also features a video interview on this topic.
Click Here
HsCRP is one of the most widely studied markers of
inflammation in cardiovascular disease: statement from the director of
National Heart, Lung, and Blood Institute