Statins Benefit People With Low, High Cholesterol
Statin therapy may be as effective in reducing heart attack, stroke, the need for artery-opening procedures, or heart-related death in people with normal or even low cholesterol but elevated high sensitivity C-reactive protein (hsCRP) as in patients with high cholesterol, according to research reported in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.
Doctors would need to treat approximately 20 patients with high hsCRP (a sign of inflammation) and normal cholesterol levels with a statin for five years to avoid one incident of the primary end points of heart attack, stroke, percutaneous coronary intervention (a catheter-based procedure to reopen blocked arteries), or one cardiovascular-related death, researchers said.
The number needed to treat (NNT) value — 20 patients in this case — is a commonly used metric that helps doctors evaluate therapies.
"Those NNT values are comparable or even superior to NNT values we already consider acceptable to prevent cardiovascular disease with statins in people with high cholesterol levels, where the 5-year NNT values range from 44 to 63," said Paul M. Ridker, M.D., lead author of the study and director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston, Mass.
The lower the NNT the better, because it means fewer patients would need to be treated to reap a benefit, he said.
Ridker was also lead investigator for the Rosuvastatin in the Prevention of cardiovascular Events Among 17,082 Men and Women with Elevated Levels of C-Reactive Protein: the JUPITER Trial, from which the data for the recent study was drawn.
The JUPITER researchers reported in November 2008 that giving 20 milligrams of rosuvastatin to patients with high hsCRP and normal or low LDL was associated with a 54 percent reduction in heart attack, a 48 percent reduction in stroke, a 46 percent reduction in need for bypass surgery or angioplasty, and a 20 percent reduction in total mortality compared to controls who got a placebo.
"These are patients who would not be treated with statins in current guidelines," Ridker said.
"Understanding the effectiveness of different therapies is crucial to the current health care reform debate. This study suggests that many patients outside our current treatment guidelines could benefit substantially from statin therapy."