The JUPITER Study — Is the News as Encouraging as It Seems?

November 18, 2008
Category: Uncategorized

Every major news wire service was abuzz this past week over Crestor. The study released November 9 involved 18,000 patients, and supplied powerful evidence that statins save lives by driving down blood cholesterol and reducing inflammation in arteries as measured by high blood levels of C-reactive protein.

In the study published in the New England Journal of Medicine, people with normal cholesterol but high levels of inflammation (CRP levels) experienced 54% fewer heart attacks, 48% fewer strokes, 45% fewer angioplasties or bypass surgeries, and 20% fewer deaths after taking Crestor.

According to James Stein of the University of Wisconsin School of Medicine and Public Health, seven million Americans (normal cholesterol, high CRP) would qualify for treatment under this JUPITER protocol. (JUPITER stands for Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin.) The cost is about $116 per month or $9.7 billion annually plus the cost of a highly sensitive CRP blood study. Dr. Stein indicates that the cost of saving one life would total $557,000. Using generic statin medications, the cost would drop to $24,000 to save a life.

The public health dilemma is over the use of Crestor, the strongest statin drug on the market, in apparently healthy people. It could add nearly $10 billion a year to our nation’s medical bill due to side effects from the use of the medication, though there is no mention of these costs in the study.

More importantly, other published studies have proven that lifestyle and dietary changes can prevent heart disease with an astounding success rate. In the same issue of the New England Journal of Medicine, Harvard’s Walter Willett, MD, MPH, published the results of the Harvard Nurses’ Study which documented that:

• eating no bad fats
• eat some good fats each day
• eating only whole grains
• eating a diet rich in vegetables and fruits
• getting daily activity
• and getting some reasonable vitamin supplementation
will reduce incidence of heart disease by 83%—with a reduction of the risk of diabetes in up to 90% of the cases, and a lowered risk of obesity, which is linked to inflammation. Alas, none of the wire services heralded this news with a banner headline!

Joel Kauffman, PhD, has prepared a critical risk/benefit analysis of the clinical research done on statin drugs. Dr. Kauffman’s review notes that the side effects of statins included cancer, constipation, myalgia, myopathy, polyneuropathy, liver and kidney damage, congestive heart failure, memory loss, and amnesia. Side effects are usually said to affect 2 to 6% of patients. In fact, a recent meta-analysis noted side effects in 20% of patients above the placebo rate (65% vs. 45%), and no change whatever in the all-cause death rate for atorvastatin.

The PROSPER trial on pravastatin showed no change in the all-cause death rate, and increased cancer and stroke rates. Statins are commonly used at a dose to lower total cholesterol to < 160 mg/dL, a level noted in the report of a NHLBI conference to be associated with higher cancer rates. Statins decrease the body’s production of the essential coenzyme Q-10 and dolichol, among other things. Low Q-10 levels are strongly associated with congestive heart failure. Dr. Kauffman’s research concludes that careful examination of the literature on statin drugs reveals false premises, minimal to no benefits, serious side effects leading to very low adherence rates, and safer, low-cost alternatives for the prevention of CVD deaths.

The lifestyle approach to reducing the risk of heart disease has been pioneered and practiced by this nation’s integrative physicians in the clinical nutrition/naturopathic model—that is, counseling the patient to make wiser lifestyle choices. In the October/November issue of Integrative Medicine: A Clinician’s Journal, editor-in-chief Joseph Pizzorno examined the biannual report of the Washington Health Foundation on the health status of all fifty states. Of the ten healthiest states, seven have licensed naturopathic doctors. Of the ten least healthy states, none had licensed naturopathic physicians.

A recent article in PloS Medicine, “Disease Mongering in Drug Promotion: Do Governments Have a Regulatory Role?” poses a key question for government regulation and the “disease-du-jour” promotion by prescription drug firms.

Supporting the right of the practitioner to practice and the right of the consumer to choose is absolutely vital. It is time to reform the public health message in the US to include the medical use of clinical nutrition and science-based lifestyle medicine. Urge your elected officials to support the Wellness Doctrine effort of AAHF and like-minded organizations.

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