Statins reduce the risk of cardiovascular events by 44% in people who do not have high cholesterol but have raised high sensitivity C reactive protein, a study published in theNew England Journal of Medicine has shown.
Results from the JUPITER trial (Justification for the Use of Statins in Primary Prevention Intervention) also show that rosuvastatin reduced heart attacks alone by 54% in the same group of people. The combined primary end point was myocardial infarction, stroke, arterial revascularisation, hospitalisation for unstable angina, or death from cardiovascular causes.
The manufacturer of rosuvastatin, AstraZeneca, described the 44% drop in cardiovascular events as the greatest relative risk reduction seen in a large placebo controlled study of statins, but there were warnings about the implications.
However, John Abramson, author of Overdosed America: The Broken Promise of American Medicine and a clinical instructor at Harvard Medical School, said that the impact would be substantial in that it would increase the cost of health care in diseases that are known to be preventable by lifestyle changes. He implies that the study would encourage the use of medication, when lifestyle changes could be at least as beneficial. He also pointed out that participants in the trial were not counselled on the benefits of positive lifestyle changes during the course of the study, something that should be routine in primary practice.
The criterion for entry to the trial of a concentration of low density lipoprotein cholesterol of less than 130 mg/dl (3.4 mmol/l) was below the recommended threshold for starting statins. A concentration of high sensitivity C reactive protein of 2.0 mg/l or more was an additional entry criterion to identify people at higher risk. The protein is a marker of inflammation.
The trial of 17 802 people recruited from 1300 clinical sites in 26 countries was stopped with only 1.9 of four years of follow-up concluded, when the data and safety monitoring board noted a significant reduction in the primary end point among participants taking rosuvastatin (142 primary events in the rosuvastatin group; 251 in the placebo group). A similar reduction was seen in a combination of myocardial infarction, stroke, or death from cardiovascular causes.
