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C-Reactive Protein and Statins


Numerous studies have shown that C-reactive protein (CRP) is correlated with cardio-vascular events.  What hasn’t been shown consistently is that the use of statins lower the risk of cardio-vascular events.  The study below tries to tease out such a conclusion.  They want those above the median level for CRP to take statins—another example of Big PhARMA attempting to lower the stick for the use of statins--jk. 


The New England Journal of Medicine, June 28,2001, Vol 344:1959-1965 No 26. 


Measurement of C-Reactive Protein for the Targeting of Statin Therapy in the Primary Prevention of Acute Coronary Events

Paul M. Ridker, M.D., M.P.H., Nader Rifai, Ph.D., Michael Clearfield, D.O., John R. Downs, M.D., Stephen E. Weis, D.O., J. Shawn Miles, M.D., Antonio M. Gotto, Jr., M.D., D.Phil., for the Air Force/Texas Coronary Atherosclerosis Prevention Study Investigators

C-reactive protein levels is not correlated with total LDL to HDL cholesterol and triglyceride levels (less than 2 percent).  Wide variation in C-reactive protein levels:  quartile 1 < 0.08 mg/dl; 2 between  0.08 to 16; 3; 3 between 0.16 to .025; 4 > 0.35 mg/dl.  The risk of acute coronary events (MI, death & unstable angina) increased 17% (average) per increasing quartile. Lavostatin therapy at the end of one year reduced C-reactive protein level by 14.8%.  This change was not associated with lavostatin’s effect upon HDL to total cholesterol ratio change. {This conclusion is overly optimistic given the quoted paragraph below}  Those with both a less than median cholesterol profile and C-reactive protein did not benefit from statin therapy.  Moreover those with greater than median cholesterol had the same benefit weather or not their C-reactive protein was greater than the median.  (That they used total cholesterol to HDL ratio rather than the STANDARD of LDL to HDL ratio suggests that the authors are teasing out positive results}. 


“In these data, the observed efficacy of lovastatin in preventing acute coronary events was not statistically significant among the participants with lipid levels and C-reactive protein levels that were both higher than the median. However, in each of the two subgroups defined according to these criteria, the point estimates of effect indicate an overall net benefit with lovastatin. Furthermore, there was no evidence of any statistically significant difference between the efficacy of lovastatin among the participants with lipid levels and C-reactive protein levels that were both higher than the median and its efficacy among those with lipid levels higher than the median but C-reactive protein levels lower than the median; these data suggest that any small differences between the results in these subgroups probably represent the effects of chance. Finally, because the rates of events were high among participants with lipid levels and C-reactive protein levels that were both higher than the median, the number needed to treat in these subgroups was well below the number considered the threshold for justifying treatment for primary prevention. Indeed, the number needed to treat among participants with lipid levels and C-reactive protein levels that were both higher than the median was of similar magnitude to that found in subgroups in which the efficacy of lovastatin was clearly statistically significant.”



 JK comments

This study is attempting to expand the number of those treated to include all those with a C-reactive protein level above the median 0.16 mg/dl, by claiming that its 14.7% reduction resulted in a significant reduction in acute coronary events.   This study would have 50% of the untreated population treated based upon being above the median level for C-reactive protein. 


Finally, nearly 20 percent of the participants in AFCAPS/TexCAPS were taking aspirin, a drug that has also been shown to reduce the effect of C-reactive protein on vascular risk.”  This again confirms that most of the benefits of statins is from the same mechanism as that of aspirin.  Since they didn’t say that statins affect C-reactive protein more than aspirin, one can presume that its effect is no more than aspirin. 


Enter supporting content here

Those who have a financial interest in the outcome manipulate the results, Major study finds that all 37 journal articles positive effects over stated; the average was 32%. Statins cause erectile dysfunction, cognitive imparement, and cancer.  

Lipitor (2011) lifetime sales $131 billion, tops all drugs.  Plavix at $60 billion is second.



52% short term


LA Times, Health section, July 21, 2008  --  excerpts

Vytorin, the combination drug (simvastatin (better known by its commercial name Zocor) and ezetimibe--known as Zetia) prescribed to lower cholesterol, sustained another blow today, when the author of a major clinical trial announced that the medication had failed to drive down hospitalization and death due to heart failure in patients with narrowing of the aortic valve. In the process, researchers in Norway detected a significant blip in cancers in the 1,800 subjects they followed

Today's findings suggested something more ominous: the incidence of cancer -- and of dying of cancer -- was significantly higher in the patients taking Vytorin. Altogether, 67 patients on placebo developed cancer during the trial. Among subjects on Vytorin, 102 developed cancers of various kinds.*  This is the second adverse press—the first being in March 08, when the ENHANCE trial found that Vytorin fared no better than a placebo at reducing plaque buildup on the walls of patients' arteries.* *

Comments by jk

Simvastatin (Zocor) is off patent.  Thus in a scramble for profits a combination drug (on patent) was introduced.  Direct to consumer market cost $155 in 07—mainly TV ads. 

*  The pressing issue is that since the development  of Statins, the very first animal studies in the 60s it has been known that Statins increase the incidents of cancer.  However, nearly all studies done thereafter have not included cancer. 

*  Several studies have failed to find a reduction in the build of plaque, even thought the statins including Zocor, reduce LDL and cholesterol.  Few studies include the principle reason for taking a statin, namely a reduction in the death rate.  Claims for such reduction probably entail a failure to control the contravening variable, aspirin usage.  Given a pile of evidence, including the very mechanism of plaque formation, which involves inflammation process, I must conclude that the use of statins is highly suspect.  Given the harm done including cognitive impairment, weakness, and cancer, if my skepticism is born out, the harm done by statins as a course of treatment will far surpass that of VIOXX which killed over 200,000 people world wide by accelerating atherosclerosis.