Millions More Americans Might Be Placed on Statins

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But while the new analysis "provides important information about the size of the population that might be affected if the JUPITER findings get into clinical practice, it raises more question than it answers," Spatz added. "There are questions about CRP and questions about whether it would be cost-effective to treat that many people with statins."

Current guidelines do not include CRP levels as indicators for statin treatment, noted Dr. Timothy J. Gardner, AHA president and medical director of the Center for Heart and Vascular Health at the Christiana Health Care System in Delaware.

The guidelines of the U.S. Heart, Lung, and Blood Institute regarding statin use probably will be updated "in the next year or so," Gardner said, and the JUPITER results "will be carefully considered" when they are.

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"Information from the JUPITER trial has certainly alerted us to the possibility that measuring CRP as a biomarker might indicate that some older patients might benefit from statin therapy who are not on it, because they have LDL levels in the normal range," Gardner said. "It particularly might be worth looking at older men and women who have other risk factors, such as obesity, high blood pressure and metabolic syndrome."

Metabolic syndrome is a constellation of risk factors that can include insulin resistance and elevated CRP levels in addition to high blood pressure and obesity.

Still, "most cardiologists do not use CRP levels, because they have not been conclusively established as a reliable indicator of risk," Gardner said.

"Because of the JUPITER trial, many are considering using it in older patients," he said. But the heart association has taken no stand on the issue, he said.

A physician must consider more than CRP and LDL levels when making a decision about statin treatment, said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City. High blood pressure and obesity, even at borderline levels, can tip the scale, she said.

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