RPT-Crestor study seen changing preventive treatment

(Repeating item that initially moved on Sunday)

By Bill Berkrot and Ransdell Pierson

NEW ORLEANS, Nov 9 (Reuters) - A study that showed AstraZeneca's cholesterol fighter Crestor slashed deaths, heart attacks, strokes and artery-clearing procedures in apparently healthy patients has made a dramatic impression on some doctors who now expect an adjustment to preventive care guidelines.

"It's a landmark study. I think it's going to very much change the concept of primary prevention," Dr Christie Ballantyne of Methodist DeBakey Heart and Vascular Center in Houston said in an interview.

"A lot of us have thought for a long time that it makes sense to start preventive treatment early. Why wait until someone gets heart disease?," said Ballantyne, who has been involved in cholesterol and heart care for some 20 years.

"This is clearly going to influence practice and future guidelines," he added.

In the AstraZeneca-funded (AZN.L) Jupiter study, which was unveiled at the American Heart Association meeting here on Sunday, middle-aged subjects with low cholesterol but elevated levels of a protein that has been linked to heart disease who took Crestor had a 45 percent reduction in serious heart problems and 20 percent reduction in death from all causes compared to those who received a placebo.

"These are extremely impressive clinical event reduction results. It reduced mortality by 20 percent in only 1.9 years and reduced all of the other events by between 40 percent and 50 percent," said Dr Carl "Chip" Lavie, director of cardiac rehabilitation and prevention at the Ochsner Heart and Vascular Institute in New Orleans.

For every 25 patients treated with Crestor in the 17,802-patient study, one serious heart event was avoided and one death was prevented for every 180 patients. All were subjects who would not be prescribed statins under current cholesterol guidelines.

The study may not only widen use of the popular cholesterol medicines known as statins to patients previously considered at low risk for heart disease, but puts C-reactive protein -- an indication of arterial inflammation -- in the spotlight.

An editorial on the Jupiter study in the New England Journal of Medicine did not recommend routine measurement of C-reactive protein, saying that current guidelines calling for testing patients deemed to have an intermediate heart disease risk "remains reasonable."

"I believe that this study will expand the use of statins even further in primary prevention," Lavie said. "And although the nicely written editorial suggests against this, I also believe that it will expand the use for CRP testing in clinical practice."

Ballantyne is all for it.

"I order CRP testing frequently. In primary prevention when trying to decide someone's risk it's an inexpensive test.

"Cardiovascular disease is the No. 1 cause of pain, suffering and death in the U.S. We can change this, so I'm in favor of a more aggressive approach," Ballantyne said.

Ballantyne found particular significance in data that showed the same life-saving benefits in women, an undertreated portion of the population, as men.