A study acronymed 'Jupiter' has come out showing that cholesterol drugs (statins) can reduce the occurrence of heart attacks among persons without a prior history of disease and who otherwise seem to be at low risk. Most experts recommend that statins be used among persons who’ve already had a heart attack (to prevent a repeat attack) as well as among persons multiple risks factors, such as tobacco use, diabetes or a very high blood cholesterol level. Lowering the threshold of use for statins among healthier persons could dramatically increase the use of this class of drug.
CRP remained an historical curiosity until researchers began to find an association between slightly elevated CRP levels (more than 2 mg/L) and heart attacks. Scientists began to wonder if aspirin not only thinned blood but treated some sort of inflammation involving the vascular system. It’s also been known for a long time that statins reduce heart attack rates more than can be explained by just the lowered cholesterol levels; there are other drugs that lower cholesterol just as much but don’t have the same survival rates. What’s more, statins have been shown to lower CRP levels. The American Heart Association even noted that CRP testing could be used to help decide whether statin treatment was warranted in borderline high risk cases.
The overall rate in the drug group was .77 per 100 person-years (mathematically, think of this as 77 persons among 10,000 taking the drug per year) versus 1.36 per 100 person-years (or 136 among 10,000 persons on the placebo). You can see what happened to the rates of individual types of cardiovascular events here. The authors calculated the all important number needed to treat with a daily dose of rosuvastatin to prevent one event was 95 persons for 2 years. To give you a sense of comparison, about 25 persons with a history of heart attack have to be treated with a beta blocker for only one year to save a life.
Take-aways from the DMCB:
You’d think that MCOs would be happy to economically trade increased use of statins for reduced heart attacks, but a) the budget for pharmacy is usually disconnected from medical cost savings in most settings and b) the absolute reduction in heart attacks (just over .5%) is relatively small.