Statin Might Help More People Fight Heart Disease Than Thought

Statins are known to lower CRP levels, in addition to cholesterol levels.

The JUPITER trial randomized almost 18,000 men and women with LDL cholesterol levels less than 130 milligrams per deciliter (130 is considered "borderline high") and CRP levels of 2 milligrams per liter or higher (considered average risk) to take 20 milligrams of Crestor daily or a placebo.

Men were 50 years or older, while women were 60 or older, with no history of cardiovascular disease, no diabetes and no uncontrolled hypertension.

"These people would not have been candidates for statins," Weintraub said. "The use of statins right now is entirely related to LDL cholesterol."

The trial was halted after only two of four planned years of follow-up, when researchers noted a significant reduction (44 percent) in the primary endpoint -- a composite of cardiovascular events including heart attack, stroke and death.

Crestor reduced LDL levels by 50 percent and CRP levels by 37 percent.

"We estimate that the application of this simple screening and treatment strategy, when used over a five-year period, would prevent more than 250,000 heart attacks, strokes, revascularizations and cardiovascular deaths in the U.S. alone," said study author Dr. Paul Ridker.

However, one expert was more cautious.

"We cannot say CRP is a risk factor nor a causal mediator," said Dr. Andrew Tonkin, head of the cardiovascular research unit at Monash University in Melbourne, Australia. "I don't think we would screen everyone, not at all at this time. We need to know the absolute risk reductions."

The findings do indicate that women could be taking statins for primary prevention, Gotto said. But the specific age group these findings relate to needs to be kept in mind.

Weintraub doubted that the benefit would be seen with all drugs in the class of statins. "There are features in each of the drugs that makes it better or not as good an anti-inflammatory agent," he said.

More information

The American Heart Association has more on C-reactive protein.

SOURCES: Howard Weintraub, M.D., clinical director, Center for the Prevention of Cardiovascular Disease, New York University Langone Medical Center, New York City; Suzanne Steinbaum, D.O., director, women and heart disease, Lenox Hill Hospital, New York City; Antonio M. Gotto Jr., M.D., dean and professor, medicine, Weill Cornell Medical College, New York City; Andrew Tonkin, M.D., head, cardiovascular research unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Paul Ridker, M.D., Eugene Braunwald professor of medicine, Harvard University, and Brigham and Women's Hospital, Boston; statement, Elizabeth G. Nabel, M.D., director, U.S. National Heart, Lung, and Blood Institute; Nov. 20, 2008, New England Journal of Medicine