Sunday, November 9, 2008
News from JUPITER (and New Orleans)
I'm at the AHA Scientific Sessions conference in New Orleans, and I'd be remiss if I didn't write about the big news of the day--the JUPITER trial.
Briefly, the trial randomized 17,802 patients with normal LDL but high hsCRP to either rosuvastatin or placebo. The patients had no history of cardiovascular disease, though some had risk factors like hypertension, obesity and smoking. The authors found that those who took rosuvastatin had:
-54% fewer heart attacks
-48% fewer strokes
-46% lower need for revascularization
-20% fewer deaths.
These findings held up across gender, race, ethnicity and Framingham scores greater than or less than 10%; there were no differences in cancer rates or serious side effects between the groups, either. There was also no difference in patients who had a BMI above or below 25.
The results are a big deal, of course, because half of stroke events and heart attacks are in people whose cholesterol seems fine, so doctors want to figure out a way to identify these people in advance.
Lead study author Paul Ridker, MD, said at a press conference that the results indicate providers could prevent 250,000 deaths over a five-year period. But discussant Andrew Tonkin, MD, said he'd like to see an absolute risk reduction done for various subgroups, as well as a cost analysis, before anyone starts ordering CRP labs willy-nilly.
"I do think we need to review the guidelines of where CRP sits in risk evaluation," Dr. Tonkin said.
The research still doesn't answer the question of whether lowering LDL or lowering CRP is the most important action, Dr. Tonkin added. Either way, said Dr. Ridker, the study provides some serious support for the safety and efficacy of statins.
"We have so many patients who are nervous about taking statins," Dr. Ridker said. "But the overwhelming evidence is that these drugs, as a class, are highly effective at lowering hard end points."
Labels: AHA Sessions, statins
posted by Jessica Berthold at
10:03 AM
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Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert
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Albert Fuchs, MD, FACP, graduated from the
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also did his internal medicine training. Certified by the American
Board of Internal Medicine, Dr. Fuchs spent three years as a
full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
Zackary
Berger
Zackary Berger, MD, ACP Member, is a primary care
doctor and general internist in the Division of General Internal
Medicine at Johns Hopkins. His research interests include
doctor-patient communication, bioethics, and systematic reviews.
CasesBlog
Ves
Dimov, MD, ACP Member, is an allergist/immunologist and Assistant
Professor of Medicine and Pediatrics at the University of Chicago,
where he evaluates and treats both pediatric and adult patients.
David
Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally
renowned authority on nutrition, weight management, and the
prevention of chronic disease, and an internationally recognized
leader in integrative medicine and patient-centered care.
db's
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Robert M. Centor, MD, FACP,
contributes short essays contemplating medicine and the health care
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DrDialogue
Juliet
K. Mavromatis, MD, FACP, provides a conversation about health topics
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Dr.
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Matthew Mintz, MD, FACP, has practiced internal
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Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid
changes in science, medicine, health and healing in the 21st century.
FutureDocs
Vineet
Arora, MD, FACP, is Associate Program Director for the Internal
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at the Pritzker School of Medicine for the University of Chicago. Her
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Gut
Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist
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I'm
dok
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Just
Oncology
Richard Just, MD, ACP Member, has 36 years in
clinical practice of hematology and medical oncology. His blog is a
joint publication with Gregg Masters, MPH.
KevinMD
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Pho, MD, ACP Member, offers one of the Web's definitive sites for
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MD
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David
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Kimberly Manning, MD, FACP,
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Peter A. Lipson, MD, ACP Member, is a
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The blog, which has been around in various forms since 2007, offers
musings on the intersection of science, medicine, and culture.
Other blogs of note:
American
Journal of Medicine
Also known as the Green
Journal, the American Journal of Medicine publishes original clinical
articles of interest to physicians in internal medicine and its
subspecialities, both in academia and community-based practice.
Clinical
Correlations
A collaborative medical blog started
by Neil Shapiro, MD, ACP Member, associate program director at New
York University Medical Center's internal medicine residency program.
Faculty, residents and students contribute case studies, mystery
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Interact
MD
Michael Benjamin, MD, ACP member, doesn't accept
industry money so he can create an independent, clinician-reviewed
space on the Internet for physicians to report and comment on the
medical news of the day.
PLoS
Blog
The Public Library of Science's open access
materials include a blog.
White
Coat Rants
One of the most popular anonymous blogs
written by an emergency room physician.
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