Preventive Medicine

The JUPITER study (just published in the New England Journal of Medicine) solidly demonstrates that treatment of healthy middle-age and older people with low cholesterol values but elevated levels of an inflammatory marker (high-sensitivity CRP) with a powerful statin (Crestor) can substantially reduce the incidence of heart attacks, strokes and death. We need to reconsider our use of this test and its place in our approach to cardiovascular risk evaluation and treatment in each of our patients.

A new study, code-named Jupiter, has been released at the cardiology meetings in New Orleans, showing that Crestor (a statin drug) reduces heart disease and stroke in people whose cholesterol levels were already low, but where one test (the C-reactive protein) was elevated. What does this mean for you?

The NYTimes today had an excellent and long piece on the use and probable overuse of the cardiac CT angiogram. The essence of the argument was that the CT angiogram of the heart was only occasionally helpful while costly in money and radiation exposure. The cardiac calcium score, which I have and continue to recommend frequently, differs in important ways, including much lower radiation and lower cost. Most important, we use it primarily to reaffirm the negative, that healthy “risk factors” really are accurate, because the cholesterol and blood pressure predictors of cardiovascular health are good but hardly infallible. Even the Framingham Heart Study is incorporating cardiac calcium scores in their risk evaluations.

The Study: A superb study concerning the cardiac calcium score was published in December 2007 in the Archives of Internal Medicine. It looked at about 3600 women aged 45 to 84 who were considered to be at low risk of heart disease (less than 10% chance in the next decade) according to the Framingham Risk Score. That score is based…