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 it’s 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. It’s
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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