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November 10, 2008

Heart Attack, Stroke and Cardiovascular Risk Can Be Halved even if you have Low Cholesterol


Statins can help lower heart attack risk by 50% even if you have low cholesterol but do have a high level of C-Reactive protein (6 million people in the United States fall into this category and 250,000 fewer cardiovascular events - strokes, heart attacks, could avoided over five years if those 6 million were given this treatment and the results of the study were duplicated.)

The New England Journal of medicine study is here "Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein"

The study included about 18,000 apparently healthy men and women with normal cholesterol but higher than normal levels of high sensitivity C-reactive protein, a marker of inflammation that has been linked to heart disease.

All of the study participants had LDL cholesterol levels of less than 130 milligrams per deciliter when they entered the trial, and none had known diabetes or heart disease. But they did have high-sensitivity CRP levels of 2.0 milligrams per liter or higher.

Blood hsCRP levels of less than 1 milligram per liter are indicative of low cardiovascular risk, while 1 to 3 milligrams per liter indicates moderate risk, and greater than 3 indicates high risk, Ridker says.

About 9,000 study participants were treated with 20 milligrams per day of Crestor and an equal number of participants took a placebo.

When the trial was stopped after a median follow-up of 1.9 years, statin users had lowered their LDL cholesterol by an average of 50% and their hsCRP by 37%.

There were also half as many heart attacks, strokes, and deaths from cardiovascular causes among the participants taking the statin. In all, 0.9% of statin users had one of these events, compared to 1.8% of placebo users.


The Wall Street Journal reports, an analysis by study statistician Robert Glynn of Brigham estimated that applying the Jupiter findings to medical practice for six million Americans for five years would prevent 250,000 major cardiovascular events. The study suggests 25 patients would need to be treated for five years to prevent one major event, a number Dr. Ridker says appears at least as cost effective as strategies screening for high LDL.






The study raises important questions about the role of high-sensitivity CRP in assessing cardiovascular risk.

The test is increasingly used by cardiologists but has not been considered a routine test for heart disease risk, mainly because its impact on treatment decisions has not been clear.

These findings, along with two other studies presented this weekend in New Orleans, could change this.

The studies, supported by the National Heart, Lung, and Blood Institute (NHLBI), showed the hsCRP test to be valuable for evaluating risk after a first heart attack or stroke.

In a written statement, NHLBI Director Elizabeth G. Nabel, MD, notes that the three studies provide the strongest evidence so far that hsCRP testing is a useful marker for cardiovascular disease.

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