Dramatic JUPITER Findings Fail To Sway Prescribing Behavior, Poll Shows

Main Category: Cardiovascular / Cardiology
Also Included In: Cholesterol;  Statins;  Clinical Trials / Drug Trials
Article Date: 26 Nov 2008 - 0:00 PDT

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JUPITER, a clinical trial suggesting rosuvastatin may lower the cardiovascular risk of healthy patients with elevated CRP, should not prompt universal statin use in older adults, according to a national poll directed at health professionals. Some 1,212 participants took part in the online poll conducted by medical news site MedPage Today LLC (http://www.MedPageToday.com).

While the news coming out of the American Heart Association (AHA) Scientific Sessions on JUPITER was dramatic, respondents voted 60% to 40% against automatically prescribing statins in patients 60+ without elevated cholesterol.

"Our poll shows that healthcare professionals may not be so quick to change their Crestor or statin prescribing habits based on the results presented at AHA," said Robert Stern, President and CEO of MedPage Today. "The JUPITER results have created a debate between clinical data and the implications for real-world medical practice."

Whether the indication for Crestor should be expanded dramatically to include healthy patients became a major question after the JUPITER findings were presented at AHA and then published online in the New England Journal of Medicine.

In the clinical trial, 20 mg of rosuvastatin (Crestor) taken daily for just under two years reduced median LDL cholesterol to 55 mg/dL, down from a median of 108 mg/dL, and median hs-CRP (high-sensitivity C-reactive protein), a test measuring inflammation, by 37%. The corresponding reduction in the rate of heart attack, stroke, bypass surgery, or cardiovascular death was 44%.

MedPage Today poll participants registered mixed views as to the best preventive cardiovascular strategy, with most alternating between lifestyle changes and drug therapy.

Among the majority of those voting against lifelong drug therapy was one M.D., who commented, "The American people want the magic bullet that will allow them to continue their unhealthful lifestyles when they should lower their BMI to between 25 and 22, restrict caloric intake and [increase] exercise. What are the costs? Low."

The same physician lamented that funding more sound research into the biological origins of inflammation with the potential of devising activity and dietary strategies to prevent type II diabetes and cardiovascular disease is neither commercially viable for pharmaceutical corporations nor sufficiently funded by NIH and is thus "not likely to happen."

A second M.D., wary of statins, objected to placing people on medications who ostensibly don't need them. "Statins have side effects such as myopathy and ED with decreased libido in men and women," he observed. "Recently they have been associated with cognitive impairment and possible early development of Alzheimer's."

A third agreed, saying, "The side effects and potential for serious problems [with statins] outweighs the benefit. Muscle weakness is common, and often does not go away until months after stopping. Don't do it."

Statins, like any other drug, have side effects, "but research and time have shown their efficacy in lowering cardiovascular events," countered a general practitioner. Speaking for the minority of those who favor statins among the healthy elderly, he commented, "As family physicians, we are intended to [practice] preventive medicine." The combination of LDL <130 and CRP >2 should be "the golden key" for receiving treatment.

The JUPITER results, the G.P. continued, speak for themselves. "Billions of dollars will be saved," with fewer cardiovascular events, hospital days and engagement in rehab programs. "In practice, altering patient habits is not easy, and even when [patients] achieve the goal, how long will it be maintained? I inform the patient and let him decide."

MedPage Today polls are not scientific samplings of reader opinion; they are, rather, a snapshot of current thinking among the healthcare community. Totals may not add to 100% due to rounding and sample size.

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