Introduction and post idea, courtesy of John Wrenn, MD – Ilene
Are you ready for your Crestor? Maybe lifestyle modification would be just as effective or possibly even more so.
Thanks goodness they listed the absolute risk reduction numbers at the end of the article. The needed to treat number is 500 to prevent one adverse cardiovascular outcome (stoke/MI). Crestor is $3.50 a day which works out to $638,000 per year for every event avoided and that doesn’t include the cost of the doctor’s visits or the liver function tests to monitor for toxicity or the cost of side effects.
Risks Seen in Cholesterol Drug Use in Healthy People
By DUFF WILSON, NY TIMES
With the government’s blessing, a drug giant is about to expand the market for its blockbuster cholesterol medication Crestor to a new category of customers: as a preventive measure for millions of people who do not have cholesterol problems.
Some medical experts question whether this is a healthy move.
They point to mounting concern that cholesterol medications — known as statins and already the most widely prescribed drugs in the United States — may not be as safe a preventive medicine as previously believed for people who are at low risk of heart attacks or strokes.
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See also John’s Take On The Prostate.
& Treat the Risk, Not the Cholesterol: Study Challenges Current Cholesterol Recommendations
(Ilene’s yellow highlights)
ANN ARBOR, Mich., Jan. 22 /PRNewswire-USNewswire/ — A new study by the University of Michigan Medical School and VA Ann Arbor Health System challenges the medical thinking that the lower the cholesterol, the better.
Tailoring treatment to a patient’s overall heart attack risk, by considering all their risk factors, such as age, family history, and smoking status, was more effective, and used fewer high-dose statins, than current strategies to drive down cholesterol to a certain target, according to the U-M study.
While study authors support the use of cholesterol-lowering statins, they conclude that patients and their doctors should consider all the factors that put them at risk for heart attack and strokes.
[…]
In the recent study, U-M physicians who worked with Yale University School of Medicine used data from statin trials that included Americans ages 30-75 with no history of heart attack.
Study authors evaluated the benefit of five years of treatment that was tailored, on coronary artery disease risk factors such as age, family history, diabetes, high blood pressure, smoking status, and recently CRP, C-reactive protein.
The tailored approach was more efficient (more benefit per person treated) and prevented substantially more heart attacks, strokes and cardiovascular deaths than the currently recommended treat-to-target approaches.
The tailored strategy treated fewer individuals with high-dose statins and saved 500,000 more quality-adjusted life years.
"The bottom line message — knowing your overall heart attack risk is more important than knowing your cholesterol level," Hayward says. "If your overall risk is elevated, you should probably be on a statin regardless of what your cholesterol is and if your risk is very high, should probably be on a high dose of statin," the U-M physician says.
"However, if your LDL cholesterol is high, but your overall cardiac risk is low, taking a statin does not make sense for you," Hayward says. "If your cholesterol is your only risk factor and you’re younger, you should work on diet and exercise."
Research has increasingly emerged questioning the value of cholesterol targets and which of statins mechanisms is most important to preventing cardiac events. Cholesterol-lowering drugs work by blocking a key enzyme linked with LDL cholesterol production, but they initiate other changes in the body.
"Statins also affect inflammation on the inside of our blood vessels which is often what causes heart attacks and strokes — it’s not just a matter of cholesterol alone," he says.
