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More May Benefit From Cholesterol Drugs

Study Shows More Would Qualify for Statin Treatment if Levels of C-Reactive Protein Are Considered
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WebMD Health News

Jan. 13, 2009 -- Eight out of 10 middle-aged and older Americans may benefit from treatment with cholesterol-lowering statin drugs, a new analysis suggests.

Researchers concluded that 11 million older people who are not considered candidates for treatment with statins under existing guidelines would qualify for treatment if guidelines were changed to reflect the findings of a landmark trial published last November.

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Known as the JUPITER trial, that study was designed to determine if adults with normal-to-low cholesterol would benefit from statin treatment.

All the participants had elevated levels of high-sensitivity C-reactive protein (hsCRP) -- a marker of inflammation that has been linked to heart disease.

The trial was stopped early after the benefits of the therapy became clear.

Over an average of two years of treatment, participants who took the statin Crestor had half as many heart attacks, strokes, and deaths from cardiovascular causes as participants randomly assigned to receive a placebo.

Statins: Who Benefits?

In the newly reported analysis, researchers used a nationally representative health database to estimate the number of people who would be candidates for treatment with statins if current guidelines were changed to include people with normal low-density lipoprotein (LDL) cholesterol levels but elevated hsCRP.

Using data from the CDC's 1999-2004 National Health and Nutrition Examination Survey (NHANES), they concluded that:

  • 33.5 million (25%) American men 50 and older and women 60 and older take a statin.
  • Based on existing guidelines, an additional 33% middle-aged and elderly people should be taking statins but are not.
  • 11 million more middle-aged and older Americans (19%) would be considered candidates for statin therapy if guidelines were changed to include adults with elevated hsCRP.

"We are talking about millions of additional people who might benefit from treatment with statins, but there are many questions that remain unanswered," says researcher Erica S. Spatz, MD, of the Robert Wood Johnson Clinical Scholars Program at Yale University, which funded the analysis.

It is not clear, for example, if the health benefits derived from treating millions of additional people justify the costs.

And the JUPITER trial also raised important questions about the role of hsCRP testing for determining cardiovascular risk.

Spatz points out that most of the people in the trial who were identified as new candidates for treatment with statins shared many of the characteristics of people who qualify for treatment under existing guidelines.

Who Should Be Tested?

Compared to people with no indication for treatment, the JUPITER patients were more likely to be female, elderly, obese, and have high blood pressure.

They were also more likely to have a collection of risk factors linked to diabetes and heart disease known as metabolic syndrome.

American Heart Association (AHA) President Timothy Gardner, MD, says identifying chronic inflammation in patients with these risk factors may be beneficial.

Gardner is medical director of the Center for Vascular Health at Christiana Care in Wilmington, Del.

"I think the idea of measuring the C-reactive protein biomarker in some patients is warranted, and I would probably start with patients who are obese, hypertensive, or have metabolic syndrome," he tells WebMD.

While the new analysis suggests that the vast majority of elderly people in the U.S. would benefit from treatment with statins, Gardner urges caution.

"Some physicians might favor putting all older patients on statins, but it is important to remember that no drug is without potential risks," he says. "The challenge in front of us is identifying those patients for whom this treatment is cost-effective and appropriate."

Spatz did not participate in the JUPITER trial, which was funded by Crestor manufacturer AstraZeneca. Her study appears today in the AHA journal Circulation: Cardiovascular Quality and Outcomes.

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Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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