March 31st, 2010
New York Times Orbits JUPITER
Larry Husten, PHD
A front page story in Wednesday’s New York Times questions the expanding use of statins, and particularly rosuvastatin, in “healthy people.” Following the recent approval of broad new indications for the drug based on results from the JUPITER trial, Times reporter Duff Wilson notes that millions of people may now take the drug “largely as prevention” and that some experts “suggest the benefits may not outweigh any side effects.”
The article quotes Stanford’s Mark Hlatky: “It’s a good thing to be skeptical about whether there may be long-term harm from healthy people taking a drug like this.”
By contrast, JUPITER principal investigator and longtime advocate of CRP, Paul Ridker, told Wilson: “We found a 55 percent reduction in heart attacks, 48 percent reduction in stroke, 45 percent reduction in angioplasty bypass surgery.” His view is supported by Steve Nissen: “If somebody comes into my office and meets the criteria, am I going to deny them a drug that reduces their chance of a heart attack or stroke by 40 or 50 percent?”
But, the article notes, the absolute difference in heart attacks in JUPITER was only 0.2%.
A quote from a cardiologist in Rockville Centre, NY, Steven Seiden, concludes the article: “It just turns a lot of healthy people into patients and commits them to a lifetime of medication.”
2 Responses to “New York Times Orbits JUPITER”
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These patients with inflammation weren’t necessarily healthy – it’s just that no one had scanned/imaged their arteries non-invasively, and demonstrated substantial plaque burdens that they all likely had (statins don’t prevent vascular events at a median of 1.9 years in patients with zero plaque to give rise to such events).
Article somewhat brutal but mostly true
First off, we don’t even know from Jupiter if HS-CRP identified subjects at risk or was it the additional other risk factor that identified the risk. As you know, without the other risk factor, treating subjects with elevated HS-CRP alone did not result in reduction of events.
Although Jupiter demonstrated a reduction in MI risk, it did not demonstrate a reduction in coronary death. Over 600,000 dollars to prevent one heart attack and no reduction in cardiac death is a hard expenditure to justify.
I thought that The Times was a bit harsh with Ridker, accusing him of getting “undisclosed royalties” from HS-CRP and suggesting that he promotes it for the income. I have never seen Ridker reveal any direct monetary reward from HS-CRP although he does disclose potential indirect benefits to his institution. I would be shocked if Ridker was actually getting direct royalties that he has not disclosed.
Competing Interests: I have a financial investment in an EBT heart scanner which in MESA was shown to be 10 times more powerful than HS-CRP in identifying MI risk. I also have a financial interest in an ultrasound machine that in MESA was shown to be 2 times more predictive of MI risk than HS-CRP.