كتب الكاتب الفاتح جبرا المتوفرة بمعرض الدوحة
|
|
 Statins could reduce the risk of heart attacks and strokes for everyone
|
Statins could reduce the risk of heart attacks and strokes for everyone, even those with healthy cholesterol levels
The new statin drug that cuts the risk of heart attacks and strokes for EVERYONE
By Jenny Hope
A new statin drug dramatically cuts the number of heart attacks and strokes, even for people without high cholesterol
In a major trial, daily treatment with Crestor slashed the rate of heart problems and deaths by 44 per cent
Crucially, the U.S. study involved those who would not normally be considered at risk of heart problems
Their cholesterol was at 'healthy' levels that would not qualify them for statin treatment in the UK and many other countries
But they all had high levels of a protein linked to heart disease. Now the U.S. researchers want this factor to be considered when deciding who will receive statins.
British experts say the study could open a new era in assessing people's risk of heart attacks and strokes
The trial, called Jupiter, involved almost 18,000 people - one in seven of them from the UK. They all had high levels of a protein called hsCRP - high sensitivity C-reactive protein - which is linked to inflammation in the arteries
Crestor, which is already available on the NHS, cut these levels and also halved levels of the 'bad' cholesterol known as LDL.
Heart attacks were cut by 54 per cent, strokes by 48 per cent and the need for angioplasty or bypass by 46 per cent among the group on Crestor compared to those taking a placebo or dummy pill
Those taking Crestor, also known as rosuvastatin, were actually 20 per cent less likely to die from any cause
The results were so dramatic that the trial was stopped in March, halfway through its planned four-year run, because it was considered unethical to keep giving placebos to half the patients
The results of the study will be released today at a meeting of the American Heart Association in Chicago
More than four million Britons regularly take statins to control cholesterol. Eight out of ten use the cheapest generic drug, simvastatin, which costs just £1.42 a month
Crestor, which is made by AstraZeneca, costs £26 a month for a 20mg dose
Experts warned against trying to replicate the effects of Crestor - the newest and most effective statin - by using other statins at higher doses
Professor Martin Cowie, professor of cardiology at the National Heart and Lung Institute, Imperial College, London, said it was apparent that some statins worked differently from others
He said simply giving patients massive doses of other statins would not necessarily work and could push upside effects to unacceptable levels
Professor Cowie pointed out that GPs and cardiologists are under increasing pressure to cut the drugs bill by putting patients on the cheapest statins. He said: 'I sympathise with the need to consider costs but you have to balance risks and benefits amid this push to switch patients to generic drugs.'
Dr Sarah Jarvis, women's health spokesman for the Royal College of General Practitioners, said the Jupiter findings were 'extremely exciting' and meant hsCRP levels were becoming an important measure of heart health. She said: 'The study shows a 50 per cent reduction in LDL for all patients, and we've never had a big enough study to demonstrate this in women before
'This high-intensity statin saves lives with safety and tolerability levels that other statins can't match.
'To get this kind of effect from simvastatin, for example, would mean increasing the dose so high that you get horrendous side effects, as other research has now proved.'
Professor Jim Shepherd, professor of Vascular Biochemistry at the University of Glasgow-Royal Infirmary, said last night: 'The study has significant implications for the future of cardiovascular risk management.'
The benefits to men and women in the trial were nearly twice what doctors expect from statins among patients with high cholesterol
However, experts warned against trying to replicate the effects of Crestor - the newest and most effective statin - by using other statins at higher doses
The lead researcher on the Jupiter study was Dr Paul Ridker, director of the Centre for Cardiovascular Disease Prevention at Brigham & Women's Hospital in Boston, Massachusetts.
He said: 'Half of all heart attacks and strokes occur in men and women with normal cholesterol.
'We've been searching for ways to improve detection of risk in those patients.
'We can no longer assume that a patient with low cholesterol is a safe patient.'
A Danish study released last month appeared to rule out Creactive protein as a cause of heart attacks. But the Jupiter team said high hsCRP levels could indicate a greater chance that fatty plaques in the arteries could break off and cause stroke or heart attack.
Volunteers in the Jupiter trial were middle-aged men and women with hsCRP levels averaging more than four times the preferred level.
Professor Peter Weissberg, medical director at the British Heart Foundation, said last night: 'The Jupiter study is the first to show that rosuvastatin reduces heart attacks and saves lives, even in people whose cholesterol is not raised. It strongly supports the "lower is better" approach to cholesterol management.
'However, further studies are required to determine if measuring C-Reactive Protein is the right way to identify people likely to gain most from treatment.'
Jupiter stands for Justification for the Use of statins in primary Prevention: an Intervention Trial Evaluating Rosuvastatin
http://www.dailymail.co.uk/health/article-1084345/The-n...ERYONE.html?ITO=1490
|
|
 
|
|
|
|
|
|
|
|
Re: Statins could reduce the risk of heart attacks and strokes for everyone (Re: Mohamed Omer)
|
Matthew Herper is a Senior Editor at Forbes
Missing The Point On Crestor
I think a lot of the debate on the Jupiter study of AstraZeneca's Crestor is way off-base in all sorts of ways, on all sides. But here's a key distinction health wonks and investors should both make. The study will increase statin use and Crestor sales, but not for the same reasons
Jupiter will increase the use of statins (many of them generic) because it provides the strongest evidence yet that a statin will reduce just about anybody's relative risk of getting a heart attack or stroke. So the only question is whether your absolute risk is high enough to justify getting it down
Jupiter will increase sales of Crestor because it shows the drug is effective, adds a halo effect regarding its safety, and, eventually, gives AstraZeneca's sales reps something to talk about in the doctor's office. It will also probably make for some nice direct-to-consumer ads, and may give Crestor an edge over Vytorin from Merck and Schering-Plough, which has not been shown to prevent heart attacks or strokes, in formulary discussions
Crestor doesn't suddenly need to become the main statin for primary prevention. It just needs to grow sales. Not every patient with high C-reactive protein, the blood test used to screen patients for Jupiter, needs to get Crestor. Some will take generics
In fact, Jupiter might also be a gift to Pfizer, because it could lead insurers to favor Lipitor more because Lipitor is almost as potent as Crestor but will be generic in a few years. Merck's Zocor got a big boost right before it went generic as plans started switching patients to the cheaper drug. Could the same thing happen for Pfizer
http://blogs.forbes.com/sciencebizblog/2008/11/missing-the-poi.html
| |
|
|
|
|
|
|
|
|
|
Re: Statins could reduce the risk of heart attacks and strokes for everyone (Re: Mohamed Omer)
|
Published at www.nejm.org November 9, 2008 (10.1056/NEJMoa0807646)
The New England Journal of Medicine
Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein
Paul M Ridker, M.D., Eleanor Danielson, M.I.A., Francisco A.H. Fonseca, M.D., Jacques Genest, M.D., Antonio M. Gotto, Jr., M.D., John J.P. Kastelein, M.D., Wolfgang Koenig, M.D., Peter Libby, M.D., Alberto J. Lorenzatti, M.D., Jean G. MacFadyen, B.A., Børge G. Nordestgaard, M.D., James Shepherd, M.D., James T. Willerson, M.D., Robert J. Glynn, Sc.D., for the JUPITER Study Group
Editor's note: We invite readers to submit comments on the JUPITER trial in a new interactive feature, Clinical Directions – The JUPITER Trial: Will You Change Your Practice? Commenting closes November 26, 2008
http://content.nejm.org/cgi/content/full/NEJMoa0807646?resourcetype=HWCIT
| |
|
|
|
|
|
|
|
|
|
Re: Statins could reduce the risk of heart attacks and strokes for everyone (Re: Mohamed Omer)
|
The Crestor Study Tells Us…? Mark Zucker Explains
By Ed Silverman // November 10th, 2008 // 4:53 pm
http://www.pharmalot.com/2008/11/the-crestor-study-tell...ark-zucker-explains/
The hoopla over the Jupiter study, which measured levels of a protein called CRP that can indicate arteries are inflamed and point toward heart disease, is prompting debate over a number of points - the extent to which CRP should be used as a guidepost for treating cholsterol, the wisdom in prescribing AstraZeneca’s Crestor and other statins to people with low cholesterol, and the study results themselves. An online survey run by The New England Journal of Medicine, so far, shows that 52 percent of respondents say the results will not likely have a significant impact on prescribing, 26 percent say it will likely have a significant impact, and 22 percent appear uncertain, according to Sanford Bernstein analyst Tim Anderson. We chatted with Mark Zucker, a heart treatment specialist at the St. Barnabas Health Care System and president of the American College of Cardiology’s New Jersey chapter, for some perspective. This is an excerpt
Pharmalot: What did the study tell you?
Zucker: It’s not unknown in the medical community that statins decrease inflammation. Therefore, the idea that statins might lower CRP isn’t at all surprising…What is surprising and reassuring is that we saw an effect in a relatively short period of time…It also suggests that our general sense, in the past, the the benefits of statins extend beyond their cholesterol-lowering effects is probably correct…In the short run the impact may be hard to asses, but in the long run, the study may have a profound impact on how we treat patients and shifts the paradigm from treatment to prevention
Pharmalot: Well, should everyone be tested for CRP?
Zucker: CRP is certainly a strong predictor of additional risk above and beyond cholesterol and LDL. For that reason, it is not unreasonable to screen patients for CRP elevations at least once during their 40’s or early 50’s
Pharmalot: Should statins now be given to people with high CRP and low LDL?
Zucker: That’s the crux of the study - what to do with patients with elevated CRP and acceptable LDL? Let’s first keep in mind that the target level of total cholesterol and LDL is somewhat arbitrary. We accept 70 mg/dl as the target, but in agrarian societies and in newborns, the LDL is generally less than 50 to 60 mg/dl. So, in reality it is unclear if the LDL in these patients was optimal. It probably wasn’t. It was just not particularly elevated by our standard. If you do choose to prescribe statins more liberally, this study provides at least some preliminary data to support your position. Nevertheless, putting patients on a statin to lower the CRP is certainly not an approved indication and does place the physician at some risk. At a minimum, one ought to recheck the CRP after three to six months of treatment just to ensure that the desired effect was achieved, otherwise, you might as well discontinue it until more data is available
Pharmalot: Should Crestor be widely prescribed? And what about other statins?
Zucker: A few points need to be considered. First, Crestor was the only drug studied. Second, it is the single most potent statin on the market. Third, Crestor it is expensive and it is not available as a generic. The cost treating the over 7 million Americans who might fall into the Jupiter cohort would be measured in the billions of dollars. Admittedly, upfront costs may save costs downstream by preventing CAD, CHF and CVA’s. Unfortunately, it’s a very hard analysis to perform. Certainly, the costs would be less if generically available statins had the same effect. This is not known and it is not good science or medicine to assume that all members of the class of statins will likewise decrease CRP. It may be true, but this is as yet unproven. From my point of view, additional studies will need to be done with other statins before recommending widespread use of Crestor or any of the sister statins
Pharmalot: What are the caveats?
Zucker: The study ran less than two years and there has been chatter among physicians over the past year or two that there might be an association between low LDL and the risk of cancer. While most of us are not convinced by the data, it would probably have been more prudent to not stop the study early and to instead follow all of the patients out for a longer period of time to make certain that no untoward or unexpected problems develop
Pharmalot: What about the higher incidence of diabetes?
Zucker: The absolute percentage difference between the cohorts was fairly small, although admittedly statistically significant. However, if you do enough analyses in any given study you always run the risk of finding something that looks statistically significant when it really isn’t. Let’s wait for additional data. Also, one would have expected that with all of the other statin trials done over the past 20 years, this ’signal’ would have already been noted
| |
|
|
|
|
|
|
|
|
|
Re: Statins could reduce the risk of heart attacks and strokes for everyone (Re: Mohamed Omer)
|
Quote:
سلاماات
اخد لى دواء انا ما حتاجاه "بفرض انو انا ما عندى كلسترول" عشان ما يجينى heart attacks and strokes . و انا اصلا عارفه اذا كانت ح تجينى heart attacks and strokes او لا؟؟؟؟
دى حركات من شركات الادويه عشان كمان يشرونا ادويه احنا ما محتاجنها |
والعجب الصايد ايفيكت حقت الاستاتين كان قريتيها لو عندك كولسترول يمكن ما تبلعيها!
الآم عضلات أقل شئ!
ودى بتعمل فى الكبد عمايل يا جدعان!
تليف ويمكن سرطان!
جنى
| |
|
|
|
|
|
|
|
|
|
Re: Statins could reduce the risk of heart attacks and strokes for everyone (Re: Mohamed Omer)
|
C-reactive protein
C-reactive protein (CRP) is a plasma protein
CRP levels rise dramatically during inflammatory processes occurring in the body
CRP rises up to 50,000 fold in acute inflammation, such as infection
Arterial damage is thought to result from inflammation due to chemical insults. CRP is a general marker for inflammation and infection, so it can be used as a very rough proxy for heart disease risk. Since many things can cause elevated CRP, this is not a very specific prognostic indicator. Nevertheless, a level above 2.4 mg/l has been associated with a doubled risk of a coronary event compared to levels below 1 mg/l
Recent research suggests that patients with elevated basal levels of CRP are at an increased risk of diabetes,hypertension and cardiovascular disease
The JUPITER trial was conducted to determine if patients with elevated high-sensitivity CRP levels but without hyperlipidemia might benefit from statin therapy. Statins were selected because they have been proven to reduce levels of CRP. The trial found that patients taking rosuvastatin with elevated high-sensitivity CRP levels experienced a decrease in the incidence of major cardiovascular events
| |
|
|
|
|
|
|
|
|
|
Re: Statins could reduce the risk of heart attacks and strokes for everyone (Re: Mohamed Omer)
|
Central City woman part of Crestor trials
By Harold Reutter
The Grand Island Independent
Posted Nov 16, 2008 @ 12:06 AM
GRAND ISLAND — The JUPITER trial made medical headlines on Nov. 9 when it was reported that the medical program was being ended early because the results were so positive
The report said that even people with low cholesterol dramatically lowered their chances of dying or have a heart attack if they took rosuvastatin, which is sold under the brand name Crestor, according to The Associated Press
While the results were announced to an American Heart Association conference in New Orleans on Nov. 9, Evelyn Robinson of Central City knew eight months ago that a medical trial had gone so well that it was being ended early
That's because Robinson was one of the thousands of people in 26 countries who were part of the trial, which was nicknamed JUPITER for Justification for the Use of Statins in Primary Prevention: Intervention Trial Evaluating Rosuvastatin
Robinson said her physician is Dr. David Colan of Grand Island. She said Colan's office contacted her more than two years ago to see whether she was interested in participating in the drug trial
Robinson said the medical office then sent her written information to review before she made a final decision on whether to participate
She said she normally only visits Colan's office for an annual checkup or whenever she's ill.
As part of the trial, she made more frequent trips between Central City and Grand Island to have blood samples drawn
Whenever she had blood drawn before entering the trial, Robinson said, she usually had one vial drawn by a phlebotomist. During the drug trial, that increased to three vials of blood. But she said that never caused her discomfort or concern
"They did a good job of vampiring me," she joked
Robinson said she was willing to enter the trial because she viewed the blood tests as a good way to have her health monitored at no expense. She also hoped the trial might help people with medical problems
The Associated Press reported that more than 17,800 people in the United States and 25 other countries participated in the trial.
Forty percent of the participants were women, which was significant because many previous statin studies have included few women, the AP story said. One-fourth of trial participants were black or Hispanic
AP also reported the following information:
Trial guidelines mandated that men had to be 50 or older, with women in the study needing to be 60 or older
Participants also were supposed to have low LDL cholesterol, below 130, and a high level of C-reactive protein or CRP
The study was undertaken because half of all heart attacks occur in people with normal or low cholesterol
As a result, medical researchers wanted to see whether high CRP levels might be a risk factor in causing heart attacks. CRP is a measure of inflammation
Participants in the drug trial received either a placebo or Crestor. Neither participants nor their doctors knew who was taking what
The study was originally supposed to run five years, but it was ended after 1.9 years because of the positive results
AP reported that "Crestor reduced a combined measure -- heart attacks, strokes, heart-related deaths or hospitalizations, or the need for artery-opening surgery -- by 44 percent."
Dr. Paul Ridker of Harvard-affiliate Brigham and Women's Hospital in Boston led the study. Ridker reported that the study revealed that heart attack risk was reduced by 54 percent, stroke by 48 percent, and the chance of needing bypass surgery or angioplasty by 46 percent
Those were the results that caused the trial to be ended early
But as with all medical studies, the results come with caveats, which The Associated Press also listed
Ridker is a co-inventor of the patent of the test for high CRP levels. Also, British-based AstraZeneca PLC, the maker of Crestor, paid for the study. Ridker and other authors of the study have consulted for AstraZeneca, as well as other statin makers
Study results were published in the New England Journal of Medicine
AP also reported a number of other caveats or cautions. It said more people in the Crestor group saw blood-sugar levels rise or were newly diagnosed with diabetes
The story also quoted Dr. Sidney Wolfe, who has campaigned against Crestor in the past, as saying Crestor has the highest rate among statins of a rare, but serious, muscle problem
Saying the good benefits are unlikely to accrue specifically to Crestor, Wolfe raised the question of whether there are safer and less expensive ways to get the same benefits. AP reported that Crestor costs $3.45 per day versus less than $1 per day for generic statins
AP reported that if 7.4 million people -- the estimated number of Americans with normal or low cholesterol but high levels of CRP -- took Crestor, it would cost $9 billion per year to prevent about 30,000 heart attacks, strokes or deaths
AP quoted Dr. Thomas Pearson of the University of Rochester School of Medicine and Dentistry as saying that is a high price tag, unless a person comes from a family with a history of heart disease or other heart disease risk factors
AP said researchers did not know whether the benefits seen in the study are because of reduced CRP levels or lower cholesterol, because Crestor did both things
Nevertheless, AP quoted Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, as saying that the JUPITER trial, as well as two other government-sponsored studies, "provide the strongest evidence to date" for testing CRP levels and adding it to traditional risk measures
For her part, Robinson was not aware of all the debate caused by the study. But she said she was happy to be part of a study that might help others
"I told Peggy (Klein, a nurse at Internal Medical Associates in Grand Island) that I would be in another study," she said
| |
|
|
|
|
|
|
| |
Mohamed Omer
smart_ana2001
jini
فيس بوك
تويتر
انستقرام
يوتيوب
بنتيريست