American College of Physicians: Internal Medicine — Doctors for Adults ®

Monday, March 30, 2009

Statins, polypills, and more from JUPITER

Not surprisingly, the American College of Cardiology '09 meeting underway in Orlando is chock-a-block with new studies about statins. Herewith, a summary of statin-related research presented today and yesterday:

  • Is there a polypill in your future? A phase II study of 2,053 healthy Indian subjects suggests the answer could be yes. Researchers tested the "Polycap"--which combines three low-dose blood pressure-lowering drugs, a statin and an aspirin--and compared it to eight other drug therapies (each comprising one or more of the drugs in the polypill). The polypill performed best, reducing risk of heart disease by 60% and stroke by 50% without any more side effects than would occur from one or two of the medications. (Hard endpoints weren't measured in the 12-week study; BP, cholesterol and heart rate were.)

Lead researcher Salim Yusuf, DPhil, FRCPC said the five-in-one pill could reduce cost and increase compliance in those already taking the medications. And, pending future trials, it may even become something that virtually everyone over 50-55 years takes, since most people have some sort of CV risk factor by that age, he said. When questioned about whether the magic pill might lead folks to skimp on diet and exercise, Dr. Yusuf responded: "I sincerely hope this wouldn't become an excuse for McDonald's to market the polypill, and put it in with their purple hamburger."
(Click "More" below to continue reading post ...)

  • More news from Jupiter. New results from the famed JUPITER study suggest 20 mg of rosuvastatin per day can cut the risk of VTE by 43%. The trial of 17,802 healthy folks with LDL of less than 130 mg/dL and CRP of 2 mg/L or higher found reduced risk whether or not a person had certain "triggers" for VTE, like recent hospitalization or trauma. The study is online at NEJM.

  • One more hat in the ring for routine CRP testing. An RCT of 15,548 healthy people who took 20 mg rosuvastatin or placebo found that those who took statins and reached LDL and CRP goals had a 65% lower risk of cardiovascular events. This compared to a 36% lower risk for those who took the statin but didn't achieve one or both goals. The goal was less than 70 mg/L for LDL levels, and less than 2 mg/L for CRP, but those who reached more aggressive goals showed even greater reduction in CV risk. Patients were followed for a median of 1.9 years, and had LDL of less than 130 mg/dL at enrollment, meaning they didn't qualify for statins under current guidelines.

  • Still, statins don't work on everyone. Specifically, they don't work on patients with high CV risk who are undergoing hemodialysis. Researchers assigned 2,776 patients age 50-80 to either 10 mg/day of rosuvastatin or placebo for three months. By the end, there was no difference between groups on the combined endpoint of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; nor was there a difference in all-cause mortality. This, despite a 40% lowering of LDL levels in the statin group. "I think vascular disease is so different, and involves a lot of calcification that may not be treatable with statins. So for hemodialysis patients who have undergone at least 3 months in treatment, statins don't seem to be beneficial," said lead researcher Bengst Fellstrom, MD, of University Hospital in Uppsala, Sweden. The study is online via NEJM.

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Anonymous Anonymous said...

i think this pill should be made available immeadiately but i doubt it will because of the drug companies.

March 30, 2009 at 7:01 PM  
Blogger Jessica Berthold said...

Thanks for the comment, Anonymous. Dr. Yusef, the lead researcher, seemed to think more research needed done. But if all goes well in that department, the pill could be widely available in the next 5-10 years, he said.

March 31, 2009 at 10:05 AM  
Blogger Lily said...

They say this new polypill will be inexpensive. That's not what happened when Caduet came out. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18! Don’t pressure your doctor into giving you something just because it’s new. Do your homework.

March 31, 2009 at 3:20 PM  
Anonymous Anonymous said...

One possible problem associated with the new polypill is that people may start to use it as a substitute for diet and exercise. This video I saw today does a good job of summing up the issue by showing what different news outlets are saying about it:

March 31, 2009 at 7:19 PM  
Blogger Jessica Berthold said...

Lily-- You're certainly right; drug companies stand to make a lot on this pill, so I'm sure the price pressure will be on.

Anon-- Thanks for the link. Dr. Yusef's comment about including the pill in with a Happy Meal was in response to that very question-- whether the pill will demotivate people to diet/exercise. Esp. since folks aren't doing such a great job with exercise and diet already.

April 1, 2009 at 11:12 AM  

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he 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.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

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.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

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.

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.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

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 quizzes, news, commentary and more.

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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