An article published today in the Los Angeles Times reported results of the JUPITER trial: Daily use of a specific statin drug in apparently healthy people reduced by 50% the chances of heart attack and stroke over two years. Furthermore, the odds of undergoing heart angioplasty or coronary artery bypass surgery were also reduced by 50%, and the odds of death by any cause were reduced by 20%.
The Jupiter trial enrolled men over 50 and women over 60 with normal cholesterol levels but elevated high-sensitivity C-reactive protein. The study was terminated after two years of follow-up. The study drug was rosuvastatin, manufactured by AstraZeneca and sold in the U.S. as Crestor at a cost of $3.45 per day (U.S.), according to the LA Times.
Do not assume that the drug’s beneficial effects demonstrated in JUPITER are a class effect applicable to all statin drugs such as Lipitor, Zocor, and Mevacor. If they are, let those drug manufacturers spend the time and money to prove it.
Critics of the study say that widespread similar use of statins in healthy middle-aged and older individuals would cost $9 billion a year in the U.S.
Who can wrap their brain around $9 billion a year? The recent U.S. Wall Street bail-out was $700 billion. The U.S. government just gave insurance company AIG another $40 billion. So $9 billion is chicken scratch, right?
Again according to the LA Times article, Dr. Mark Hlatky of Stanford University calculated the NNT - the number needed to treat - to prevent one heart attack, stroke or death over two years. That number is 120. In other words, to prevent one heart attack, stroke, or death over two years, 119 people have to take the drug daily for two years, with no benefit to them. At the outset of this preventive “treatment,” a given individual has less than a one percent chance of benefiting from treatment over the next two years.
At $3.45 per day, the drug costs $2,518 for two years. This doesn’t include the cost of physician visits and blood monitoring for toxicity. At the end of two years, what do you do? Your doctor is likely to recommend taking the drug indefinitely.
Does this sound like a good deal to you? Will you be that lucky one out of 120 to benefit? Can you think of better ways to spend your $2,518 over the next two years?
Would you consider other ways to prevent heart attack, stroke, and death, such as losing excess weight, quitting smoking, getting regular exercise, and switching to a traditional Mediterranean diet?
Popping a pill is easier, no doubt.
Let’s say you decided to spend your $2,518 on something other than Crestor. But your health insurance will pay for it. Would you take the pill then?
Remember, AstraZeneca isn’t going to give the drug away for free. They’ve spent millions on development and testing. Someone has to pay for it, whether it’s you, your health insurer, or your employer. If the latter two pay, won’t that be reflected in higher insurance premiums or lower paychecks?
Steve Parker, M.D.
Ridker, Paul, et al. Rosuvastin to Prevent Vascular Events in Men and Women With Elevated C-Reactive Protein. New England Journal of Medicine, online November 9, 2008. DOI: 10.1056/NEJMoa0807646
Hlatky, Mark. Expanding the Orbit of Primary Prevention - Moving Beyond JUPITER. New England Journal of Medicine, online November 9, 2008. DOI: 10.1056/NEJMe0808320
O’Riordan, Michael. JUPITER hits New Orleans: Landmark study shows statins benefit healthy individuals with high CRP levels. HeartWire, November 9, 2008.
Szwarc, Sandy. In-depth skeptical analysis at Junkfood Science. Ms. Szwarc spent more effort analyzing the JUPITER study than 99.9% of Crestor-prescribing physicians ever will.