DRHOOK- Crestor smile: Drug slashes health risks
Cheeseburgers, French fries, and BBQ potato chips would be my choice of foods if I were stuck on a desert island. (Hmm, sounds like Lost.) After all, my health would be my last concern if I were destined to live the rest of my life on a lonely island.
But I know some people right here in the middle of civilization who just don't care about their high cholesterol. One dude said to me there was no proof that high cholesterol is associated with heart attacks or strokes. (I also know people who don't think HIV causes AIDS.)
Many credible studies have shown that high cholesterol increases the risk of cardiovascular problems– but even Christopher Columbus didn't convince everyone the world was round.
Does cholesterol-lowering medicine save lives?
Crestor is a statin drug that is very powerful in lowering LDL, the bad cholesterol. For some funny reason, all the Crestor studies are titled with an outer space name. The "Meteor" study showed how Crestor reduces atherosclerosis in the carotid arteries (something most other cholesterol-lowering medicines can't claim). There is even a "Uranus" study (but that sounds more like a proctology investigation).
Now the "Jupiter" study is in the New England Journal of Medicine. This study was very impressive, and I don't have any financial ties with AstraZeneca.
I did an epidemiological review on the "Jupiter" study for Crestor, and it was done well. This study was actually stopped early– after a median of 1.9 years– because the study strongly showed the drug saves lives– more than any other lipid-lowering study has ever shown.
It was a very large double-blind, placebo-controlled, randomized clinical trial involving over 17,000 participants in 26 countries. The folks were mostly white men, but still a good percentage of women (38 percent) and non-white (29 percent).
In general, the folks were overall healthy, meaning they hadn't had a cardiovascular problem like a heart attack or stroke. Their problem was an elevated high sensitivity C-Reactive Protein (CRP). CRP is measured in the blood and is associated with heart disease.
Well, of course, in this day and age, most of the folks were overweight and 41 percent had Metabolic Syndrome X (big belly, high blood pressure, glucose intolerance). But these folks didn't have a high LDL, and so they were never on cholesterol medicine.
Guess what? The folks taking Crestor 20mg a night had 56 percent fewer major cardiovascular events than the folks taking a placebo, with a major statistical significance. In epidemiology, a 56 percent benefit is like winning by 100 points at the Super Bowl. (I can't believe I just used a football analogy.)
Showing more than a 20 percent benefit is hard to do in research. So it's amazing that Crestor showed 46 percent benefit in reducing fatal and nonfatal heart attacks, 52 percent benefit in fatal and nonfatal strokes, and 20 percent benefit of death for any reason at all. (Hmm, I'm tempted to eat a cheeseburger everyday while on Crestor, but I won't. Sigh.)
Also there's a question of how much money will be saved by Crestor's preventing cardiac interventions (such as stents and angioplasties) because there was a 53 percent benefit in the conditions that lead to those interventions.
There wasn't increased muscle breakdown or liver toxicity on Crestor, though as with other statins there seems to be a slight increase in developing diabetes.
I find it interesting when a drug has amazing results, it is touted as a "class effect" (i.e. all statins have the same benefit), but if there's a bad side effect, it's then considered a "specific drug problem" (like only Drug X is dangerous. We ain't! No, sir-ee!)
But as significant as the "Jupiter" study is compared to any other cholesterol-lowering study, I think it‘s going to be pretty hard to beat Crestor.
Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.