The JUPITER study has been the subject of countless headlines reporting the unprecedented reduction in heart attacks with the cholesterol drug, Crestor®. The study has received gushing pronouncements of the inestimable value of statins by my cardiology colleagues.
Pharmaceutical giant, AstraZeneca, sponsored this study of nearly 18,000 people (men 50 years and over, women 60 years and over). Participants took 20 mg per day Crestor or placebo for two years.
The premise being explored was whether a cholesterol drug like Crestor® yields any benefit in people without high cholesterol but with a high measure of the body's inflammatory state, c-reactive protein, or CRP. Participants therefore were selected to have starting LDL cholesterols in the "normal" range of no higher than 130 mg/dl and elevated CRP of 2 mg/dl or greater.
Crestor® treatment resulted in 44% reduction in nonfatal heart attack, nonfatal stroke, hospitalization for unstable angina, revascularization (bypass surgery, stents) and death from cardiovascular causes. The reduction in nonfatal heart attack was most marked at 55%.
Before we consider what this study means to those of us interested in prevention of heart disease, let's discuss: What is C-reactive protein (CRP)?
What is C-reactive protein (CRP)?
CRP is a blood-borne protein that originates in the liver and serves as an index of the body's inflammatory state. It is triggered by yet another inflammatory signal molecule, interleukin-6.
What triggers this cascade of inflammatory markers? Any inflammatory stimulus will trigger an increase in CRP, such as being overweight, lack of exercise, vitamin D deficiency, viral illness no matter how trivial, any inflammatory disease like arthritis, small LDL, high triglycerides, poor diet rich in processed foods, resistance to insulin, any injury, incipient diabetes, hidden cancer, lack of education (no kidding), etc.
In other words, many, many conditions, from trivial to serious, trigger increased inflammatory markers like CRP.
A recent analysis (Genetically elevated C-reactive protein and ischemic vascular disease of persons with genetically elevated levels of CRP here) suggests that CRP does not, by itself, cause atherosclerotic disease. CRP is therefore simply a marker for conditions that heighten inflammatory responses.
It has already been confidently demonstrated that, the higher the CRP, the greater the future risk of heart attack, cancer, and diabetes. That is no longer in dispute. What is not entirely clear is whether reduction of CRP is beneficial to health.
Back to JUPITER.
First of all, let me make clear that I am not a fan of prescription drugs. I view drugs as a necessary evil necessary in selected situations, e.g., antibiotics for pneumonia or wound infection, clot-busting drugs when blood clots are present, and acute or catastrophic situations. I am definitely not a fan of drugs in chronic conditions whenever they can also be addressed with simple, more natural means.