JUPITER study ushers in new paradigm

MANILA, Philippines - Local heart experts agree with their foreign colleagues that findings of a new landmark study will change the way doctors treat apparently healthy and low-risk patients.

The JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial was presented during the last convention of the American Heart Association by Dr. Paul Ridker of the Brigham and Women’s Hospital, in Boston, Massachusetts, and published online in the New England Journal of Medicine.

Dubbed by some heart experts as a blockbuster trial, it showed that treating apparently healthy individuals with rosuvastatin 20 mg significantly reduced heart attacks, stroke, hospitalization for unstable chest pains, need for angioplasty or bypass surgery, and confirmed death from cardiovascular causes by 44 percent compared with individuals treated with placebo or dummy pills.

Dr. Romeo Divinagracia, president and executive director of the University of the East Ramon Magsaysay Memorial Medical Center, said the results of the JUPITER study provided them with a new paradigm in further reducing cardiovascular risk to reduce heart attacks and strokes, which remain as the leading cause of deaths in the Philippines.

“The results of the JUPITER study are overwhelming,” he said.

The JUPITER trial is part of AstraZeneca’s extensive GALAXY clinical trials’ program designed to address important unanswered questions in statin research.

Designed as a four-year study, JUPITER was halted due to its unequivocal evidence of reduction in cardiovascular morbidity and deaths among patients treated with rosuvastatin.

“The results (of the JUPITER study) gave us the answers,” Divinagracia said, pointing out that even a person with low or normal cholesterol level is still susceptible to develop heart disease.

As a preventive screening measure, he recommended checking patients’ high-sensitivity C-reactive protein (hs-CRP), a laboratory parameter that indicates chronic inflammation in the body that may be caused by the atherosclerotic narrowing of the artery.

Patients enrolled in the JUPITER trial had normal LDL-cholesterol levels but elevated hs-CRP. 

“Our patients must have both lower cholesterol and lower hs-CRP. Lower is better,” Divinagracia stressed.

Divinagracia, a past president of the Philippine Heart Association and Philippine College of Physicians, added that hs-CRP test may also be requested if the patient has a family history of heart disease despite normal cholesterol level.

“Even if your cholesterol is normal but you have a background, I suggest that you take this test,” he said.

He explained that there is now overwhelming scientific data that indicate that hs-CRP is an independent marker to know if one is at risk of heart problems and serious complications.

Dr. Rogelio Tangco, assistant chairman of the Department of Medicine of the University of the Philippines-Philippine General Hospital (UP-PGH), said the outcome would change their clinical practice.

“Hs-CRP will become a marker. Now, more doctors will have to prescribe it not just for heart patients but also for ordinary patients as well. This will change our entire practice,” he said.     

Diagnosing at-risk patients in apparently healthy patients through an elevated hs-CRP can help prevent hundreds of thousands of heart attacks and strokes worldwide annually.

Statistics show that nearly half of patients who develop cardiovascular events such as heart attack and stroke occur in apparently healthy men and women with normal LDL-cholesterol levels.

According to Tangco, it is better to take preventive medicines that may be hard on one’s pocket now but in the long run, will prevent one from suffering heart attack or undergoing a series of bypass operations.

“Consider the after-effects of that,” he said.