Remember the good old days when we all knew our heart disease enemy - good old cholesterol, a nice biochemical number that you could manipulate with diet, exercise and drugs?
JUPITER now says you can forget all that. No, I am not talking Greek mythology. I am talking about AstraZeneca's headline making study that gives a new twist to the statin story.
The standard cholesterol test doesn't point to heart and stroke risk with any more accuracy than smoking history, girth and blood pressure, a point exactly where we were in time fifty years ago with the Framingham data.
Back then we so desperately needed a number, any number, that cholesterol was snatched out of the "associated with" category and abruptly made it "causation" for heart disease and everybody went along with it.
Doctors got more business, the food industry welcomed a huge economic boost to food processing and the drug companies would grow to have truly immense profits.
Now we are being told by one of our leading drug companies that cholesterol is not the cardiovascular disease marker we have been led to believe for nearly fifty years, inflammation is and they have the proof.
We have been told by most doctors for some two generations now that cholesterol is causative. Insurance companies have jumped on and begun to insist their new clients meet their new, physiologically insane cholesterol requirements or pay much higher premiums or even have coverage denied.
Certain occupations such as airline piloting have fallen victim to the same brainwashing with lowered entry cholesterol requirements to levels commonly only seen in teenagers. I hope it will not take another fifty years to turn their physiologic clocks back to normal as they all face the new reality.
For those among you still bewildered as to what I am talking about, the JUPITER study took a large pool of subjects having currently acceptable, normal cholesterol levels and measured their hsCRP levels (highly sensitive, C-reactive protein).
Those that were elevated for inflammation, for that is what CRP measures, they put on Crestor 20mg (nothing magic here, just another reductase inhibitor, aka statin). The result was that both markers of inflammation (the hsCRP) and structural inflammatory markers such as intimal thickness, etc, went down.
There is not any real doubt in my mind that if any other statin had been used the results would have been the same, for all statins, being reductase inhibitors, can be expected to work the same way and atherosclerosis is an inflammatory process.
I have been saying this now for years. Cholesterol levels are irrelevant. JUPITER has just proved what I have been saying for nearly a decade now.
Now you can expect this drug company to lead the others in what amounts to a race to measure more hsCRPs in our society, looking for elevation, so they can justify their statin.
When you ask your doctor whatever happened to cholesterol, milk and eggs you will find some vacillating as he tries to explain away what has happened, but it will not be easy for he has been brainwashed just like all the rest of us.
The drug companies can't lose since statins have the remarkable property of being anti-inflammatory agents as well as cholesterol reducers. They will simply cut the dose and get more mileage from their statin and likely reduce the adverse reactions caused by relatively excessive cholesterol lowering doses they have been using.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor