November 15, 2008
I have written about the cholesterol-lowering statin drugs in this space before. All my readers know I am a big fan of these drugs, prescribe them regularly, and am not alone in my belief. Long before the new multi-center, multi-country JUPITER trial was published in the New England Journal of Medicine, I was already routinely treating patients with LDL cholesterols less than 130 mg/dl with Lipitor and Crestor. I knew that AstraZeneca had a homerun with Crestor based on the previous studies that showed that it and Lipitor prevented coronary plaque progression and decreased the number of heart attacks and strokes in those who had already sustained them.
This is known as secondary prevention, but what was missing previously was sufficient data on what we call primary prevention. Yes, previous studies have shown a reduction in cardiac events with the use of Statin drugs in patients with multiple cardiac risk factors including diabetes. But now we have the first big study looking at giving a Statin to more than 17,000 healthy men and women with an LDL cholesterol lower than 130 mg/dl. Not only was LDL reduced by 50%, and the C-Reactive Protein, a marker of cardiac risk, reduced by 37%, but there were also less heart attacks and strokes in the Crestor group versus the group that received placebo.
Critics will say that this study lasted only two years (it was stopped because the results were so dramatic), and that long term studies need to be done before firm conclusions can be drawn, but in the meantime, JUPITER is a pretty good start. Slightly concerning is the mild increase in physician-reported diabetes, but this too requires further study.
JUPITER is a homerun not only for cholesterol-lowering drugs and AstraZeneca, but for the world. Too many patients are afraid of the rare severe muscular side effect. These patients can now be shown the JUPITER trial results as verification of what many physicians had already extrapolated from much more limited data. This study is definitely a justification for expanding the pool of patients we treat with these great drugs.
Personally, I've always been more afraid of heart disease than of the tiny white or yellow pill that keeps our arteries clean. I started taking a statin drug myself years ago with an LDL of less than 130 mg/dl because my father had heart disease, long before this groundbreaking study had been conceived. JUPITER is one of many crucial antidotes against the irrational fear of lifesaving statins.
Marc Siegel, MD, is an internist and professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear