Statin Study No Substitute for Diet, Exercise, Researcher Says

November 17, 2008 01:00 PM
by Emily Coakley
Lifestyle changes should come before medicine, says a researcher whose recent study detailed the benefits of statins for people with a low heart disease risk.

After Landmark Study, A Return To Basics

Last week, news broke that a study of nearly 20,000 adults found that people with low cholesterol levels could still reduce their risk of heart attack or stroke by taking a statin known commercially as Crestor. It led to speculation that the number of statin prescriptions could skyrocket. 

But even Dr. Paul Ridker, the lead researcher of the study, suggests other interventions before a prescription

In the study, people with a high level of what's called a C-reactive protein benefited from Crestor. But Ridker shared his recommendations for someone with a high C-reactive protein score with the Boston Globe:

"The first, second, third, and fourth intervention for anyone with elevated hs-CRP is get to the gym, lose a few pounds, throw away the cigarettes, and start thinking about a healthier diet. That remains overwhelmingly the most important intervention for lowering cardiovascular risk," he said. 

Another doctor, Leslie Cho, of the Cleveland Clinic, said she recommends lifestyle changes first. 

"I'm a firm believer that we have to have patients try diet and exercise, because you can't take pills at a higher and higher and higher dose," Cho told the Globe. "I tell my patients all the time that pills are supplements, not substitutes, for a healthy lifestyle."

Background: Surprising statin research

The Jupiter trial has yielded results that are being called “landmark,” though there is plenty of skepticism, too.

The trial “found that in people whose cholesterol levels were normal the risk of a heart attack risk was reduced by 54 per cent and stroke by 48 [after taking the drug]. The combined risk of heart attack, stroke and heart-related death fell by 47%, as did the odds of undergoing surgical procedures,” reported the Daily Telegraph.

Patients in the study took a drug called rosuvastatin, which is made by AstraZeneca under the name Crestor. The pharmaceutical company also funded the study.

Those with normal cholesterol levels had a higher C-reactive protein level, which the Daily Telegraph describes as “a marker of inflammation and has been thought to indicate a risk of cardiovascular problems in the future.”

Jupiter’s results caused quite a stir at last week's American Heart Association’s meeting in New Orleans, where they were presented. When it was announced, AstraZeneca’s stock price rose in London, according to Bloomberg.

Lori Mosca, a professor of medicine at Columbia University’s College of Physicians and Surgeons, jokingly repeated a question to Bloomberg that she had heard at the Heart Association meeting: “Should we put them in the drinking water?”

Mosca had different thoughts: “Are we going to use this like aspirin therapy? This finding is clearly expanding the universe of who should receive cholesterol pills, but we need to carefully evaluate at what point it becomes cost effective to treat the majority of people.”

Opinion & Analysis: Skeptics weigh in

Nortin Hadler, a professor of medicine and author at the University of North Carolina, Chapel Hill, wrote about the results on ABC News.

The 56 percent reduction being touted, he said, “may be hard to ignore, but it calls for reflection rather than prescribing zeal. It is a reduction in a very small outcome to an even smaller outcome.”

Merrill Goozner, writing on his site, GoozNews, says the study is worth a second look, “because of what it reveals about profit-driven medical research and how it contributes to making the U.S. health care system the most bloated and wasteful in the world.”

Goozner points out that Paul Ridker, the study’s lead researcher, owns a patent on the C-reactive protein test, and AstraZeneca’s drug, Crestor, was given to patients.

“If they can get two million more ‘apparently healthy men and women’ on [Crestor], it’s an additional $2 billion-plus in sales for AstraZeneca. If they can test 10 million people to find the estimated two million with elevated CRP levels (they had to screen nearly 90,000 people to find the 17,800 eligible for the trial), it’s $200 million in test sales, which, if the royalty is only 1 percent, amounts to a hefty $2 million a year in extra income for Dr. Ridker,” Goozner wrote.

But others thought the results were significant.

The blog Pharmalot quoted Doug Weaver, the top cardiologist at Henry Ford Hospital in Detroit. “This takes prevention to a new level. It defines a new population,” Weaver said.

Related Topics: Vytorin; new ways to measure success

This hasn’t been a good year for all the drugs that fight cholesterol; most notably, Vytorin, which is a combination of the drugs Zocor and Zetia, has come under fire. A study suggested that Vytorin wasn’t more effective than Zocor alone. Another study suggested a link to cancer, though many researchers thought that was an anomaly.

The Food and Drug Administration is also exploring “whether moving away from measuring traditional benchmarks—like lowering blood sugar and bad cholesterol—may make drugs more effective overall,” findingDulcinea reported. Could CRP and the Jupiter results be part of the FDA’s new interest?

Reference: Jupiter study; cardiovascular disease, fitness and nutrition Web Guides


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