Two years ago, a large trial known as JUPITER made headlines when it showed millions more people – those with normal cholesterol levels but an increased level of high-sensitivity C-reactive protein, or CRP – could significantly reduce their risk of heart attack and stroke by taking statins. Whether expanding statin use as a preventive strategy would be cost-effective, though, remained an unanswered question – and Stanford researchers did their own research to try to find out.
In a paper appearing online today in the journal Circulation: Journal of the American Heart Association, the investigators show broader, risk-based statin use without CRP screening appears to be a cost-effective way to prevent heart attack and stroke. (The optimal strategy for men with no risk factors, for example, would be to start a statin at the age of 55.) And screening patients for high levels of CRP – which suggests a greater risk of heart problems – to identify those for whom statin therapy might be helpful, can also be cost-effective under certain scenarios.
But perhaps the most important take-away from the study is that more study is needed. Not much is known about the long-term effects of statins, for example. And it would be helpful, the researchers told me, to know whether statins work as well in low-risk people (i.e. those with normal CRP levels) as in high-risk ones, and to determine whether CRP screening can also identify which patients are likely be most responsive to statin therapy. Without this information it’s difficult to say with certainty which strategy makes the most sense:
“This is not a slam-dunk decision in terms of: You should take people at low risk and put them all on treatment,” said [Mark Hlatky, MD, senior author of the study]. “If you run the model and change the assumptions even a little bit, you get a different answer. Our model shows that we need better data to be confident about the best approach to drug treatment of lower-risk individuals.”