I'm a 52-year-old male in good health. My cholesterol profile is normal, but I do have a lot of heart disease in my family. Should I take a statin?

Your question is very timely. The U.S. Food and Drug Administration is on track to approve the expanded use of a statin called rosuvastatin (Crestor) for people with cholesterol levels previously considered normal.

The FDA is basing this decision on results of a large clinical trial called JUPITER. The results were published in the New England Journal of Medicine in 2008. Instead of using the cholesterol level as the reason for taking a statin, the researchers leading JUPITER chose the results of a different blood test called high sensitivity C-reactive protein (hsCRP). The hsCRP test detects a very low level of inflammation that you wouldn't even realize is present.

Over the past 10 to 15 years, scientists have discovered the importance of inflammation in coronary artery disease, especially heart attacks. The JUPITER study was designed to determine if rosuvastatin could decrease the risk of heart attacks in people with a normal cholesterol level but an elevated hsCRP.

The study showed daily Crestor reduced heart attacks and strokes by 50 percent. However, there were only 393 heart attacks or strokes among all 18,000 participants in JUPITER. So, only a very small number of people taking rosuvastatin had any benefit. If 200 people were taking rosuvastatin every day for a year, it would prevent one heart attack or stroke. That means the other 199 would be taking a drug that might not help them.

I would ask about these risk factors:

  • Active smoking or recently quit
  • An LDL higher than 100 mg/dL (I get concerned at 130 mg/dL or higher.)
  • High blood pressure
  • A low HDL, lower than 40 mg/dL
  • Family history of coronary heart disease, especially before the age of 60

  • Diabetes
  • If it's a close call on whether a patient needs a statin, I might order the blood test for hsCRP to make that decision. Is Crestor better than the other statins? Probably not, but it was the only one used in the JUPITER study.

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