Treating "Normal" Cholesterol Levels - January 2009

Did you know…Treating some persons with "normal" cholesterol levels may prevent heart disease?

A new study, the JUPITER trial (Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin), conducted by researchers at Brigham and Women's Hospital in Boston and colleagues, showed that a widely used cholesterol-lowering drug appears to protect against heart attacks and stroke in people who do not have high cholesterol.  The study participants receiving the drug did have high levels of C-reactive protein (CRP), which is a marker for the inflammation process leading to blockage of the arteries.

People with increased levels of CRP (which can be measured by a simple blood test), have a higher risk for cardiovascular events. About half of all heart attacks and strokes occur in apparently healthy people with lower LDL (“bad cholesterol”) levels. The medication (a “statin”) used in the study lowers both the CRP and the LDL cholesterol.

The JUPITER trial studied 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).  Men were 50 years or older, while women were 60 or older, with no history of cardiovascular disease, no diabetes and no uncontrolled hypertension, though many had pre-diabetes. The statin drug reduced LDL cholesterol by 50% and CRP levels by 37%.  The results showed that the statin treatment reduced the risk of a heart attack, stroke, death and heart procedures by 44%.  This translates to treating 25 subjects for 5 years to prevent a cardiovascular event.

What Does CPC recommend?

Measuring CRP may help to more accurately estimate risk for heart disease and may be most important to measure in persons at moderate risk of developing heart disease. In the 2003 statement the American Heart Association and the Centers for Disease Control and Prevention concluded that measurement of CRP is not useful for broad screening of the entire American adult population or those with heart disease. For those at high risk, treatment should already be aggressive and include a statin. Rather, at a physician’s discretion, it was suggested that checking CRP levels may be useful for people at moderate risk, to help decide whether or not a statin could be used as a preventive measure against heart disease. An unanswered question that remains: does lowering normal cholesterol values with a statin provide a benefit irrespective of the level of CRP? Future studies may answer this question.

The study referenced above is published in:  New  England Journal of Medicine 2008;359:2195-207, by authors Paul M Ridker, M.D., et al.