News on Gingko and C-reactive protein

Friday, October 29, 2010 // Uncategorized

12/1/2008 12:00:00 AM

I don’t know anyone who doesn’t want to improve their memory or prevent the development of dementia.  Many take Gingko biloba, an herb that has been touted to help patients with Alzheimer’s (not Oldtimer’s or ,my favorite, Anheiser’s ) based on one study years ago.  Bottom line:  It doesn’t work and it isn’t cheap. Ginko
The other big news of the past month was the Jupiter study.  This is one where they took patients with normal cholesterol levels, but who had elevated C- reactive protein levels.  Many people who have heart attacks have cholesterol levels that are in the “normal range”.  Taking a statin, in this case Crestor or Rosuvistatin, lowered the high sensitivity C-reactive protein levels (hsCRP), cholesterol and the risk of heart attack.  Unfortunately, most of my patients have high cholesterol and normal hsCRP levels and don’t fit into the same category as the study subjects.  It’s another bit of interesting information, but if you’re on a statin, I wouldn’t switch to crestor based on these results.Summary and Comment
More Data on Statins in Primary Prevention — The JUPITER Study
Among otherwise healthy patients with high hsCRP levels, rosuvastatin lowered the incidence of adverse cardiovascular events during 2 years of therapy.
The role of statin therapy in primary prevention is uncertain for patients whose cholesterol levels are not markedly elevated. Among such patients, elevated levels of high-sensitivity C-reactive protein (hsCRP) are associated with excess cardiovascular risk. In this international industry-sponsored study, 17,802 people (men’s age, 50; women’s age, 60) without known cardiovascular disease and with LDL cholesterol levels <130 mg/dL and hsCRP levels 2 mg/L were randomized to receive daily rosuvastatin (Crestor; 20 mg) or placebo. Exclusion criteria were numerous and included diabetes, uncontrolled hypertension, and various other chronic diseases.
The trial was stopped early, after a median follow-up of 1.9 years. Rosuvastatin lowered mean LDL cholesterol level by 50% and hsCRP level by 37%. The incidence of the primary endpoint (first major adverse cardiovascular event, including unstable angina, myocardial infarction, stroke, arterial revascularization, or death from cardiovascular causes) was significantly lower in the rosuvastatin group than in the placebo group (0.77 vs. 1.36 per 100 person-years; hazard ratio, 0.56); occurrence of all components of the composite endpoint was lower in the rosuvastatin group, as was the overall mortality rate (HR, 0.8). Physician-reported new-onset diabetes was significantly more common in the rosuvastatin group; median glycosylated hemoglobin (HbA1c) level at 24 months also was higher with rosuvastatin.
Comment: In this study of apparently healthy subjects with elevated hsCRP levels, statins lowered the incidence of adverse cardiovascular events; this result supports expanded use of statins in primary prevention. An editorialist sounds several cautionary notes, however, mentioning the high proportion of patients who were excluded from enrollment, the relatively modest absolute effect size (about 100 people need to be treated for almost 2 years to prevent 1 event), the higher incidence of diabetes, and the lack of long-term data on hazards of statin therapy. He also reminds us that this is a randomized trial of statin therapy, not of hsCRP testing, and he advocates selective, rather than routine, use of hsCRP testing.
— Kirsten E. Fleischmann, MD, MPH

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