Pushing Statins for More and More People

For the first time the FDA approved the use of a statin drug called Crestor for people without a history of cardiovascular disease. This is called primary prevention. This approval is based on the results of the Jupiter study. The study was funded by the Crestor drug maker, AstraZeneca, and looked at more than 17,800 supposedly healthy men and women with an average age of 66 and no history of CV disease. The subjects were followed for 1.9 years.

The drug is indicated for those with a high level of hsCRP (2.0mg/L or more). CRP is an inflammatory marker thought to be an underlying cause of cardiovascular disease. In addition to elevation of CRP, other indications for use are men over the age of 50, women 60 years or older who have an LDL cholesterol less than 130mg/dl and triglycerides less than 500.In the Jupiter trial the number needed to treat to show benefit was 95, meaning that 95 people need to be treated for 1 person to benefit. Do you want to be among the 94 who take an expensive and potentially dangerous drug when other options are less expensive, safer and proven?The results touted what sounds like an impressive relative risk reduction of 44%. In actual numbers itís a lot less impressive with only about 50 deaths difference in the more than 17,800 people in the trial. 

Are the Side Effects Worth It?

During the Jupiter study 13 deaths occurred due to gastrointestinal conditions while other subjects taking Crestor noted feelings of confusion. It is important to note that memory deficits are well known side effects of other statin drugs. Also be aware of muscle pain that may not improve even when stopping the drugs. In some people muscle damage has been fatal. The most worrisome adverse effect was an increase in type 2 diabetes among those taking Crestor. Keep in mind that type 2 diabetes is a major cause of cardiovascular disease. 

Once a drug is approved in a particular population the prescription writing begins. Will people with a family history of diabetes, obesity, those with metabolic syndrome (pre-diabetes), an increased waist-to hip ratio be properly screened before going home with a prescription for Crestor? These are people already at most risk for type 2 diabetes. How well will they be followed? How many people who have pre-diabetes will be pushed into full-blown diabetes?   

Lifestyle Targets the Underlying Cause

Aside from putting more money in the pockets of the pharmaceutical industry the practice of using drugs to treat lifestyle issues further contributes to our ever-escalating national healthcare costs without making us healthier. 

It is well know that excess body fat particularly deposited in the belly and around the organs increases the CRP. Itís also been shown that weight loss, especially controlling both the quality and quantity of carbohydrate foods, lowers CRP. Additionally, a low carb approach is very effective at dealing with metabolic syndrome and diabetes. 

Unfortunately, given the way medicine is practiced in the US it will be quicker and easier to write an Rx than explain why lifestyle changes are safer, more cost effective and have no side effects. On the other side of the coin is a population that has been trained to think that many things can be easily treated by pill popping rather than making the changes that target the underlying cause of their condition.

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