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Jupiter study emphasizes value of cardiac CRP levels

EHS Team
The results of the newly released Jupiter study headed by Dr. Paul Ridker are very interesting; and they are making cardiovascular disease (CVD) experts re-look at cardiac C - reactive protein (cCRP) as a screen. It may well be its own independent risk factor and not just a marker of other cardiovascular risks (despite the study results, this still needs to be proven).

Our review of this report, and of the editorials/reviews written about it, support EHS’s current use of the cCRP as an important cofactor in risk assessment and a helpful adjunct in deciding how aggressive we may need to be in primary prevention of cardiovascular disease (preventing one’s first event). Although the ‘~ 50% reduction in events’ is impressive as written, given the lower starting risk of cardiac events in the population studied, it would take 2 years of high-dose Crestor use in 95 people to prevent one ‘event’.

In a Forbes review of the report (Forbes—New Age For Statins?), interesting points are made about the actual Jupiter study, showing the average age of study participants, who did have some other risk factors, was 66; and their average LDL was 108. There is some fear in the medical community that the results will be extrapolated beyond the population that the study tested. That said, we think it is an important finding and one that will “tweak” our aggressiveness and our target dose of statin therapy. We have been performing this test on most of our clients at their physicals and will certainly continue to do so.

All statins reduce inflammation by various degrees. They also have varying levels of tolerance, especially at high doses. Dr. Ridker deliberately chose a high dose of Crestor to try to prove an effect; a reasonable thing to do in a study of this type. This study had difficulty early on due to the number of side effects. Also, the study does not discuss the other causes of inflammation which may drive up CRP levels; and, as recently as last week in the NEJM (see NEJM -- Genetically Elevated C-Reactive Protein and Ischemic Vascular Disease), studies have reported that CRP is not causal in vascular disease.

What is overlooked in this report is that CRP can as aggressively be lowered by weight loss (20-40% reduction), cholesterol-lowering foods (walnuts, plant sterols, etc) and high fiber diets (35-50% reduction), as well as smoking cessation. Some supplements also seem to be beneficial in reducing CRP, such as vitamin E, Coenzyme Q-10, and L-carnitine. What is also an important point about CRP is that when elevated, it proportionally increases a person’s chance of developing diabetes.

We at EHS Corporate Care are focused on optimizing wellness and disease prevention. This study adds further information for us to use to this end. It also underscores the importance of regular medical reviews and physical exams.

For many people, the take-home message of this study is to target ideal body weight, exercise daily, increase daily fiber significantly, and begin a healthier diet. If we can do this, we will reduce multiple heart attack and stroke risk factors. For your review, here is a good risk factor calculator from Mayo Clinic: Heart disease risk calculator. There is also excellent information from the American Heart Association.

Yours in health,
EHS Team

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