Doctor's Blog

Crestor and Cholesterol
May, 2009

Does everyone need to be on a cholesterol-lowering medication? A recent study in healthy men and women with a median age of 66 has got the press talking. It is well known that high cholesterol can cause heart attacks and strokes. The question that was asked in the JUPITER study was: Do statins lower the risk of heart attacks and strokes in people with normal cholesterol levels?

Statins are in a class of cholesterol lowering medications which include rosuvastatin, atorvastatin, simvastatin, pravastatin, etc. Statins decrease LDL cholesterol, decrease triglycerides, and increase HDL. Let us review the basics of cholesterol. LDL is the bad cholesterol, and HDL is the good cholesterol.

The JUPITER study tested 17,802 healthy men and women with normal LDL cholesterol and elevated high-sensitivity C-reactive protein (CRP) and found that taking a statin decreased the risk of cardiovascular events by 20%. CRP is a nonspecific inflammatory marker that has been correlated with vascular events. Statins lower both LDL and CRP.

The trial was initially scheduled for five years duration, but it was stopped after ~2 years due to the dramatic decrease in cardiovascular events. Since the trial was stopped early, the effects of long term therapy are unknown. There was a small but statistically significant increase in the diagnosis of diabetes in the study group (5.9%) versus the placebo group (5.8%). Some common side effects are muscle weakness, muscle pain and elevated liver enzymes which occurred equally in both groups. These side effects are reversible and resolve once the medication is discontinued.

So who needs to be on a statin? The 3rd report National Cholesterol Education Program (NCEP) guidelines indicate that persons with no risk factors for heart disease should have a LDL <160. For persons with 2 or more risk factors, the LDL goal is <130. Persons with coronary artery disease, diabetes, history of heart attack or stroke should have a LDL <100.

Risk factors for heart disease include:

• cigarette smoking
• high blood pressure
• low HDL <40
• family history of heart disease
• age (men > 45 year; women >55 years)

See the table below to better understand cholesterol levels. This table is based on NCEP guidelines.

LDL Cholesterol
<100	Optimal
100-129	Near optimal
130-159	Borderline high
160-189	High
>190	Very high
Total Cholesterol
<200	Optimal
200-239	Borderline high
>240	High
HDL Cholesterol
<40	Low
>60	High

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