Heart Drug 'Hype'? Docs Debate Crestor

And some physicians say the fact that the trial was stopped early could have masked safety problems that may have occurred later on.

Critics also point out that while rosuvastatin cut rates of heart attack, stroke, and heart-related deaths by nearly half, very few of those not taking the drug -- less than 2 percent -- actually suffered these conditions. In short, it appears that the vast majority of people taking the drug would not have had these problems anyway.

"The [risk] reductions were actually tiny -- less than 1 percent reduction," Prine said.

So while the study authors claim that one life may be saved for as few as 25 patients treated with rosuvastatin, some say that many more patients -- and wallets -- will be affected if CRP screening to determine who should take rosuvastatin becomes routine.

"My 'back of the napkin' calculations suggest high cost per life saved," says Dr. Mark Ebell, professor of medicine and assistant to the provost at the University of Georgia.

Finding Common Ground

It may be that doctors' hesitance to charge ahead with widespread CRP screening is based on the idea that when it comes to this type of screening, what is reasonable for a particular patient may not necessarily be beneficial for an entire population.

"We have to be smart, looking at people not [just] as individuals, but as populations, too," says Dr. Gigi El-Bayoumi, a primary care physician and associate professor of medicine at George Washington University, who is concerned that widespread CRP testing may not be the best use of our collective healthcare dollars.

But if nothing else, last month's study may vindicate those who continue to look to the CRP test to guide their decisions on whether or not to prescribe cholesterol-lowering medication.

Dr. Greg Anderson, a primary care physician at the Mayo Clinic in Rochester, Minn., says that JUPITER may lead him to order more CRPs than in the past, "particularly in people with normal LDL but with other risk factors when trying to decide how aggressively to treat." But he adds that he will be more likely to treat elevated CRP with a generic statin rather than rosuvastatin, because the former is cheaper and more likely to be covered by insurers.

Indeed, many primary care physicians and cardiologists feel that the benefits seen from rosuvastatin in JUPITER are likely to extend to all statins.

"For now, the message is clear: statins are a once-in-a-lifetime class of drugs with a comparable safety profile, and with an across-the-board body of evidence for reduction in [heart attack and stroke]," says Dr. James Januzzi, associate professor of medicine at Harvard Medical School and staff cardiologist at Massachusetts General Hospital.

For El-Bayoumi's patient Anna Dixon, who has a family history of heart disease and stroke, the results of the trial are particularly relevant. While Dixon's level of "bad" cholesterol is relatively normal, El-Bayoumi has tested her CRP. If her CRP level turns out to be high, El-Bayoumi will recommend a statin.

"Over the last five years, I've had a variety of physicians tell me various and sundry things about cholesterol," says Dixon, an associate partner at IBM consulting who has taken pravastatin (Pravachol) in the past.

"I don't want to 'not take medicine' if it's prudent that I do…but I don't want anything in my body that I don't need."

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