Archief Roodbont

Universal statin therapy in elderly ‘warrants investigation’

23 July 2009

MedWire News: Patient characteristics cannot reliably identify individuals with elevated C-reactive protein (CRP) levels, report researchers in the American College of Cardiology.

Given the benefits of statin therapy demonstrated in the JUPITER trial, the cost of measuring CRP, and the large percentage of older adults with high CRP levels, they say, universal statin therapy for older US adults “warrants investigation.”

The JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) results showed that rosuvastatin treatment significantly decreased the risk for cardiovascular disease (CVD) events in older men and women without a history coronary heart disease who had normal cholesterol but elevated CRP.

Paul Muntner (Mount Sinai School of Medicine, New York, USA) and colleagues examined patient characteristics associated with being reclassified for statin therapy based on having a CRP level of 2 mg/l or higher, and whether patient characteristics could be used to identify individuals with such elevated CRP levels.

Using data for 887 older US men and women (aged 50 or 60 years or older, respectively) from the National Health and Nutrition Examination Survey, they report that 90% had elevated CRP.

Individuals with CRP levels of 2 mg/l or higher were more likely to be current smokers, obese, and have chronic kidney disease.

But, among those not meeting criteria for statin therapy, characteristics including demographics, cigarette smoking, obesity, chronic kidney disease, and metabolic syndrome each had low positive predictive values (<70%) for identifying people with elevated CRP and negative predictive values (<60%) for identifying those with CRP levels below 2 mg/l.

Pooling characteristics did not improve the predictive ability.

“Although randomized controlled data demonstrate the benefits of statin therapy for older adults with CRP levels [of 2 mg/l or higher], the cost effectiveness and public health risks and benefits of nearly universal statin therapy for older US adults warrant further investigation,” the authors conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Am J Cardiol 2009; 104: 354–358