Tuesday, November 11, 2008

Crestor (rosuvastatin) gets new credit for preventing heart disease

And also shows the irrelevance of cholesterol. Note however that we are as usual still looking at a quite small minority of people who benefit. As it says here: "Dr. Tonkin, however, says, "The importance of intervention for individuals being treated and for public health policy depends on the absolute risk reduction, not the relative risk reduction." According to Dr. Tonkin, for example, the 20% relative risk reduction seen with rosuvastatin treatment in individuals with elevated hsCRP alone translates to a 0.055% [tiny] absolute risk reduction. "We would need to treat 190 people over the course of the study to prevent one death," he says."

A new statin drug dramatically cuts the number of heart attacks and strokes, even for people without high cholesterol. In a major trial, daily treatment with Crestor slashed the rate of heart problems and deaths by 44 per cent. Crucially, the U.S. study involved those who would not normally be considered at risk of heart problems. Their cholesterol was at 'healthy' levels that would not qualify them for statin treatment in the UK and many other countries. But they all had high levels of a protein linked to heart disease. Now the U.S. researchers want this factor to be considered when deciding who will receive statins. British experts say the study could open a new era in assessing people's risk of heart attacks and strokes.

The trial, called Jupiter, involved almost 18,000 people - one in seven of them from the UK. They all had high levels of a protein called hsCRP - high sensitivity C-reactive protein - which is linked to inflammation in the arteries. Crestor, which is already available on the NHS, cut these levels and also halved levels of the 'bad' cholesterol known as LDL. Heart attacks were cut by 54 per cent, strokes by 48 per cent and the need for angioplasty or bypass by 46 per cent among the group on Crestor compared to those taking a placebo or dummy pill.

Those taking Crestor, also known as rosuvastatin, were actually 20 per cent less likely to die from any cause. The results were so dramatic that the trial was stopped in March, halfway through its planned four-year run, because it was considered unethical to keep giving placebos to half the patients. The results of the study will be released today at a meeting of the American Heart Association in Chicago.

More than four million Britons regularly take statins to control cholesterol. Eight out of ten use the cheapest generic drug, simvastatin, which costs just 1.42 pounds a month. Crestor, which is made by AstraZeneca, costs 26 pounds a month for a 20mg dose.

Experts warned against trying to replicate the effects of Crestor - the newest and most effective statin - by using other statins at higher doses. Professor Martin Cowie, professor of cardiology at the National Heart and Lung Institute, Imperial College, London, said it was apparent that some statins worked differently from others. He said simply giving patients massive doses of other statins would not necessarily work and could push upside effects to unacceptable levels. Professor Cowie pointed out that GPs and cardiologists are under increasing pressure to cut the drugs bill by putting patients on the cheapest statins. He said: 'I sympathise with the need to consider costs but you have to balance risks and benefits amid this push to switch patients to generic drugs.'

Dr Sarah Jarvis, women's health spokesman for the Royal College of General Practitioners, said the Jupiter findings were 'extremely exciting' and meant hsCRP levels were becoming an important measure of heart health. She said: 'The study shows a 50 per cent reduction in LDL for all patients, and we've never had a big enough study to demonstrate this in women before. 'This high-intensity statin saves lives with safety and tolerability levels that other statins can't match. 'To get this kind of effect from simvastatin, for example, would mean increasing the dose so high that you get horrendous side effects, as other research has now proved.'

Professor Jim Shepherd, professor of Vascular Biochemistry at the University of Glasgow-Royal Infirmary, said last night: 'The study has significant implications for the future of cardiovascular risk management.' The benefits to men and women in the trial were nearly twice what doctors expect from statins among patients with high cholesterol.

The lead researcher on the Jupiter study was Dr Paul Ridker, director of the Centre for Cardiovascular Disease Prevention at Brigham & Women's Hospital in Boston, Massachusetts. He said: 'Half of all heart attacks and strokes occur in men and women with normal cholesterol. 'We've been searching for ways to improve detection of risk in those patients. 'We can no longer assume that a patient with low cholesterol is a safe patient.'

A Danish study released last month appeared to rule out Creactive protein as a cause of heart attacks. But the Jupiter team said high hsCRP levels could indicate a greater chance that fatty plaques in the arteries could break off and cause stroke or heart attack.

Volunteers in the Jupiter trial were middle-aged men and women with hsCRP levels averaging more than four times the preferred level. Professor Peter Weissberg, medical director at the British Heart Foundation, said last night: 'The Jupiter study is the first to show that rosuvastatin reduces heart attacks and saves lives, even in people whose cholesterol is not raised. It strongly supports the "lower is better" approach to cholesterol management. 'However, further studies are required to determine if measuring C-Reactive Protein is the right way to identify people likely to gain most from treatment.'


Soccer causes motor neurone disease?

Hard to see why. Sounds like hysteria over a random correlation

A senior doctor urged the Football Association last week to investigate whether the sport contributes to motor neurone disease (MND). "I shall be in touch with the FA about carrying out this research," said Ammar Al-Chalabi, a neurologist at King's College London. "The FA does not seem hostile to the idea."

Andrin Cooper, a spokesman for the FA, said it had no plans to conduct a "specific MND study" at present. However, he added that the organisation was involved in a 10-year study on how "heading the ball affects the brain" and that its medical committee would be meeting next year to assess the preliminary results.

Five thousand people in Britain suffer from MND, which claimed the life of David Niven, the actor, and has also felled several prominent footballers. They include Jimmy "Jinky" Johnstone, the Celtic forward, who died in 2006, aged 61, and Don Revie, the England and Leeds United manager, also 61 when he died in 1989; and Rob Hindmarch, the former Derby County and Sunderland player, who died in 2002 at the age of 41.

Al-Chalabi was a member of a research team that discovered an apparent "cluster" of three MND sufferers who played for the same amateur football club in Kent. They had another potential risk factor in common, however: all had suffered a big electric shock once in their life. "They all got the disease at the same time and two died in the same weekend," he said. "Since then it has emerged that another of their friends has got it."

Del Deamus, 34, from Welwyn Garden City in Hertfordshire, is convinced there is a link between sport and the disease. Diagnosed with MND in February, he had played football for England as a schoolboy and later as an apprentice for Tottenham Hotspur. "I heard that head injuries might be a factor and thought, that's me - I had lots of head injuries," he said last week. "But boxers don't seem to suffer from it. So maybe it's something in the grass. We just don't know."


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