The Truth About The Crestor Cholesterol Study
Nov 24, 2008 Jonny Bowden, PhD, C.N.S. is a nationally known expert on weight loss and nutrition and natural healing. A popular and dynamic speaker who combines wit and humor with science, he’s appeared as a health and nutrition expert on MSNBC, CNN, FOX News, ABC, CBS and NBC and he has contributed material to over 50 national magazines and newspapers. Dr. Bowden is on the Editorial Advisory Board of Men’s Health, is an associate editor of Total Health Magazine and is a columnist for both Better Nutrition and Remedy Magazines. His advice on nutrition, weight loss, diet and supplements has been read by millions on iVillage.com and on America Online..
He is the author of The Most Effective Natural Cures on Earth: What Treatments Work and Why, the Amazon best-seller The 150 Healthiest Foods on Earth, and his latest, The Healthiest Meals on Earth, books that have been endorsed and acclaimed by such luminaries as Mehmet Oz, MD, Christiane Northrup, MD and Mark Victor Hansen and a virtual who’s who in the field of integrative medicine and nutrition. Coming in January, 2009, 150 Most Effective Ways to Boost Your Energy. For more information about products, services and coaching as well as a free newsletter and audiocourses, please visit him at www.jonnybowden.com
Last week, the results of a new study on a cholesterol-lowering drug were released generating a ton of press attention. The study (the JUPITER study) made the front page of the NY Times, was featured on just about every television news show, and generally created a lot of buzz. Even if you weren't paying too much attention- and it was hard not to- you might have heard that the study showed that a cholesterol-lowering medication (Crestor) lowered the risk for heart disease by over 40% in people who did not have high cholesterol in the first place!
The Wall Street Journal was practically salivating in its predictions. "The findings could substantially broaden the market for statins, the world's best-selling class of medicines", they panted. "Morgan Stanley analysts predicted Crestor revenue could rise to as much as 8 billion and 18% of the global statin market in 2014".
OK let's take a look at what actually happened before we start putting statins in the water supply.
Approximately 17,000 participants were enrolled in the study, all at "prime heart attack age" (over 50 for men, over 60 for women). But none had either high cholesterol levels nor evidence of serious heart disease. By all traditional measures, they were a healthy men and women.
What they did have was elevated inflammation.
We know this because the researchers measured their blood levels for CRP (C-Reactive Protein) an excellent marker for inflammation in the body. For years and years I- and many other nutritionists and doctors- have been warning that inflammation is the real danger for heart disease and that cholesterol is a red herring. Inflammation is the silent killer. Inflammation is what we should be paying attention to. C-Reactive Protein is an important measure to know, even though most docs have scoffed at it and told us it's not that important. (Besides, they were too busy focusing on cholesterol.)
For years I've also been saying that any benefit that might be had by taking statin drugs has nothing to do with lowering cholesterol. But statin drugs have an interesting little "side effect": they happen to lower inflammation.
So here's this study when people with completely normal cholesterol (but elevated inflammation) benefit from a statin drug. Think they'd figure out that maybe cholesterol wasn't the issue in the first place?
Oh no. What you'll probably see is a movement to lower the "normal" cholesterol levels even further down so that even more people can be put on these drugs.
Which, by the way, are far from perfectly safe. Though the mainstream establishment downplays their side effects, most knowledgeable clinicians will tell you that side effects like muscle pain and fatigue are far more common than widely believed and that they see these side effects in about 15% of patients. And the drug costs $3.50 a day, if you care.
So what we have here is a study that showed a very very modest reduction in risk for heart disease, using a drug that accomplished that not by lowering cholesterol but by lowering inflammation. The benefit of the drug-- such as it was (and it was modest to say the least)--- clearly had nothing to do whatsoever with lowering cholesterol.
By the way, how can I say that the benefit was modest when it was reported as a whopping 44% reduction in risk?
Simple. Because the percentages don't tell the whole story.
The real numbers were as follows: In the non-treated group, about 14 in 1000 developed cardiovascular disease (in other words 1.4 percent of the group). In the treated group, only 8 in 1000 developed cardiovascular disease (.8 percent). Tiny numbers- but reducing 14 to 8 does produce a "44% reduction" (just as reducing 3-in-a-million to 2-in-a-million produces a 33% reduction!)
Inflammation truly is an important health issue, and anything that reduces inflammation should be paid attention to. The sad part of all this is that there are so many ways to reduce inflammation naturally without drugs. Fish oil is one of the most anti-inflammatory substances on the plant. So are the myriad of natural anti-inflammatories (like the quercetin found in apples and onions, and the hundreds of other flavonoids in the plant kingdom).
But of course none of those are 20 billion dollar-a-year businesses.
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Reader Comments (1)
A key number from the study is the "number needed to treat." In other words, how many people have to take the drug in order to prevent ONE heart attack, stroke, or death? The NNT is 120, which is an unusually high number for a medication thought to be effective. In other words, 119 people had to take the drug for two years, the duration of JUPITER, in order to prevent one heart attack, stroke, or death. The cost of the drug alone for two years is $2500 (US), not to mention the potential side effects.
[How much is a life worth? And who is to pay for it? Questions for another day]
Those 119 people that didn't benefit would be well advised to lower their inflammation and risk through diet, exercise, smoking cessation, and loss of excess weight.
-Steve
[the NNT was noted by Dr. Hlatky in an editorial in the same issue of the New England Journal of Medicine.]