Crestor, Jupitor, CRP and Heart Attack by Jeffrey Dach MD

Crestor Rosuvastatin Crestor, Jupiter, CRP and Heart Attack Prevention

by Jeffrey Dach MD

Over the years, I have convinced most of my friends and family members to avoid statin drugs for primary prevention of heart disease because all-cause mortality benefits are marginal, and statins have severe adverse side effects of muscle pain, cognitive dysfunction, nerve damage and CoQ10 depletion.  Besides, there are other more effective ways to prevent or even reverse heart disease.

Above image Crestor courtesy wikimedia.
  

Crestor The
Jupiter Study and associated editorial was published in the New England Journal of Medicine on November 9, 2008.  Press releases and media hype followed.  Since the reporters haven't read the study, they parrot back the exaggerated press releases issued by the PR firms hired by Astra-Zenecar which makes Crestor and funded the study.  Even the newspapers merely reprint the press releases and again, the reporters haven't actually read or even understand the details of the study.

Media Hype too Much for the Statin Resistant Few

My statin free friend has a slightly elevated cholesterol level, and no history of heart disease.  He asked for help because the media hype from the Jupiter study  made his family members pressure him to start statin drugs. You see, his six brothers are on statin drugs, and they all believe he should "enjoy the lifesaving benefits of statins, as well. This kind of peer pressure is hard to resist.

The media reports suggested "that even healthy people would benefit from statin drugs."  One CNN TV announcer even suggested that statins should be put into the water supply.

Here are a few of the hyperbolic news reports appearing in the media:

Healthy People Apparently Benefit From Cholesterol-Lowering Drugs
By Jessica Berman Washington 11 November 2008 Voice of America News
"According to a new study, apparently healthy people who take cholesterol-lowering drugs can dramatically reduce their risk of heart attack and stroke. VOA's Jessica Berman reports."

Study Could Widen Market For Cholesterol Treatments By RON WINSLOW

Cholesterol-Fighting Drugs Show Wider Benefit. New York Times

Wider cholesterol drug use may save lives. Associated Press MSNBC

Journalists Have a Short Memory, FDA Doctor said Crestor Should be Banned

Only 4 short years ago, November 18, 2004, FDA Director of Drug Safety David Graham shook the pharmaceutical word with
testimony to the senate finance committee in which he named Crestor as a "bad drug" that should be banned.  Here is one of many news reports about Dr. Graham and Crestor:

Concern about drug safety doesn't stop with Vioxx  by Rita Rubin, USA TODAY 11/22/2004   "Crestor. This cholesterol drug has drawn regulators' attention in Europe and Canada. At the Senate hearing, Graham said Crestor is the only statin drug that causes kidney failure. And, he said, it carries a higher risk of rhabdomyolysis than any other statin. Rhabdomyolysis is a potentially fatal muscle complication that benched another statin, Baycol, in 2001."
Jupiter Discredits the Cholesterol Theory of Heart Disease

Aside from the fact that the Jupiter study tends to discredit the cholesterol theory of heart disease because the participants had normal LDL cholesterol, what can we say about the Jupiter study? 
Here is a quick nitty gritty summary of the Jupiter Study from Michael Eades MD: "A small group of unusual patients, those with low LDL cholesterol, and high C-reactive protein, may slightly decrease their risk for all-cause mortality by taking a drug (Crestor) that costs them almost $1,300 per year and slightly increases their risk for developing diabetes." (
1

CRP C Reactive ProteinA Critical Look at Jupiter

Lets take a critical look at the study.  First of all the title of the study introduces bias from the start, JUPITER means Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin.   From the beginning, the designers of the drug trial were intent on showing that Crestor could be used for primary prevention of heart disease.  In other words, the title declares the working hypothesis to be true even before gathering the data.

Above Left Image CRP protein Courtesy of Wikimedia. 

Secondly, the lead author Paul Ridker holds the patent on the CRP test, and Astra-Zeneca, maker of Crestor funded the study.  Both stand to realize huge gains assuming a favorable outcome.  This represent a blatant conflict of interests.

Thirdly, the patients selected for the study were not healthy.  They were overweight, tended to be pre-diabetic and had chronic inflammation.  In other words, they had metabolic syndrome X.  They all had normal LDL cholesterol and elevated CRP (C reactive protein, an inflammatory marker).

8900 people were given Rosuvastatin(Crestor) 20 mg per day, and 8900 people given a placebo over 1.9 years.

Fourth, the results of the study, see table below.
 


(Table courtesy of NEJM Ridker et al Jupiter Study)

Relative vs. Absolute Numbers in Jupiter

The number of "hard" cardiac events was cut in half, reduced from 1.8 percent (157 of 8,901 subjects) in the placebo group to 0.9 percent (83 of the 8,901 subjects) in the Crestor Group.  ( "hard" event is myocardial infarction, heart attack, stroke or death from cardiovascular disease)

120 people were treated for 1.9 years to prevent one "hard" event.  Crestor costs $1,250 per year. The cost to prevent one "hard" event is approximately $300,000 which is rather costly.

Although 0.9 is 50% of 1.8, (ie the relative risk reduction is 50%).  However, the absolute risk reduction is only 0.45 per cent per year.  This is a very small number. 

Lets recap this, although the relative reduction in risk was 50 %, the absolute reduction was 0.45 per cent per year, a small number.

Death from Any Cause (click here for larger chart)


(chart courtesy of NEJM Ridker)

Notice the bottom chart with the two curves denoted by the red arrows.  These two lines are the all-cause deaths in the placebo group and the Crestor Group.  The two curves are almost superimposed indicating there is not very much difference.  Look at the upper chart with the green arrows. This is the same chart with a different scale to make the two lines separate out. The authors had to use a different scale to make it look like there was a major difference.  Also these charts are in error because the study was halted after 1.9 years, and did not extend out the 4 years indicated above.

What happens when a statin drug study is extended out six years with larger numbers of patients?  The all cause mortality chart will then look like the chart below.  Notice both lines (below chart) are superimposed with no difference in all cause mortality between the statin group and the placebo group.


The above chart courtesy of
Eddie Vos at Heart Health.org

The above chart shows mortality data from 2 large Statin drug studies, called the ALLHAT and the ASCOT with a total of 10,000 high risk patients.  Although the statin drug group has fewer cardiac events, (fewer heart attacks and hospitalizations for heart attack etc.), the all cause mortality rate is identical in the drug group and placebo group.  This lack of all cause mortality benefit is disturbing, since any really useful treatment should save lives.  Clearly, statin drugs make a lot of money but they don't save lives.

This fact is explained by the well known adverse effects of statin drugs on overall health.  These drugs deplete CoQ10 causing congestive heart failure, they cause dementia, cognitive dysfunction, nerve damage, and muscle damage.  Statin drugs are also carcinogenic in animal studies.

Adverse Side Effects in the Crestor Drug Group

Surprisingly, the Jupiter study declared there were no adverse side effects from Crestor.  Or at least the adverse effects in the drug group was the same as the placebo group.  This is hard to believe since the FDA has issued two advisory warnings about the adverse side effects of Crestor, and a public interest group represented by Sidney Wolfe (Public Citizen) petitioned the FDA to have Crestor banned because of side effects.  In addition, Crestor is one of the strongest statins and has the
worst adverse effect profile.(7)(8)(9)(10)

Ridker could say there were no adverse effects with a straight face because gimmicks were used in the design of the trial.  About 80% of the trial candidates were eliminated and "washed out " of the study the first four weeks because they could not tolerate Crestor.  The remaining candidates could tolerate the statin drug and allowed entry into the study.

Another clue about Crestor adverse effects is revealed by the thousands of lawyers taking currently taking
cases for litigation.   Questions have been raised about Crestor since a similar statin drug, Cerivastatin (Baycol), was banned in 2001 due to  severe muscle damage leading to renal failure.

Increased Diabetes in Drug Group

Another adverse side effect from Crestor which hasn't surfaced in other statin drug trials is the increased risk of insulin resistant diabetes caused by the statin drug.  Obviously, this isn't a good sign for Crestor.

A Final Conclusion about Jupiter

The Jupiter study is an excellent example of Medical Marketing masquerading as Medical Research, and represents a new low point for the pharmaceutical industry's deceptive techniques to persuade people to buy a drug that is harmful and, in fact should have been banned years ago.  Dr John McDougall summed up the Crestor/Jupiter Study with this statement: "Neither the patient nor our over-burdened health care system can thrive with this kind of deception from the pharmaceutical companies and the medical journals.  Fortunately, health care professionals are beginning to recognize that what is happening in medical care is just like the tragedies we have recently witnessed in the stock market and the housing industries.  Unregulated business practices lead to a few very rich people becoming even richer, and severe suffering for the rest of us.  The time has come for change.  Researchers and publishers must be held accountable like stockbrokers and bankers.  Regulation enacted to protect the public is long overdue."
 
No Statins for Women and Elderly

It is inadvisable to give statin drugs to women or the elderly for reasons covered in my previous article, Cholesterol Lowering Statin Drugs for Women, Just Say No by Jeffrey Dach MD (
2) and also discussed in a letter to the editor by Eddie Vos (3).  Studies have shown that reducing cholesterol in the elderly actually increases mortality rates.  And for women, after years of many statin drug studies, none of them has ever shown a mortality benefit for women.(2)

Reduce CRP Naturally without Drugs

Why take a toxic statin drug with adverse effects to reduce CRP (C Reactive Protein) when a cheaper and safer method is available?  Dr. Gladys Block came out with her
paper October 10, 2008 in which she reports that Vitamin C (1000 mg per day) reduced CRP by 23 % (similar to that of statins).(4)  Higher Vitamin C intake reduces all-cause mortality in males by 35% and in females by 10%.(5)  Higher vitamin C intake (360 mg/day) had a 27% lower risk of nonfatal MI (myocardial infarction) and fatal heart attack.(6)  There are many safe ways to reduce CRP without statins, such as weight loss, exercise, low glycemic diet, omega 3 oils, Vitamin D supplements, fiber, and many others.(11)

How to Prevent and Reversing Heart Disease - Linus Pauling Protocol

Many statin drug studies over the years show statin drugs actually reduce cardiac events in middle aged males with known heart disease or elevated CRP.  However, statin drugs do not improve all cause mortality, and some might consider this a problem when it comes to recommending statin drugs for primary prevention.  For prevention of heart disease we now turn to the...
 
Linus Pauling Protocol


Above image, Cover of Linus Pauling Protocol Book courtesy of Owen Fonorow.

Then you might ask, if statin drugs aren't it, then what is the best way to prevent or reverse heart disease?  The answer can be found in Linus Pauling Protocol Book (above image), Practicing Medicine Without a License by Owen Fonorow.(12)(17)  Owen Fonorow is perhaps the single most dedicated person devoted to the 1992 Linus Pauling Protocol for prevention and reversal of heart disease.(13)  A patent for the Linus Pauling Protocol was issued in 1994.(15)  In 1996, a CAT scan coronary calcium score study validated the protocol showing a 15% reversal of calcification indicating reversal of coronary artery disease.(14)

Stop America's #1 Killer by Thomas Levy MD, JD. Vitamin C Another excellent book on the subject of Vitamin C and heart disease is, Stop America's #1 Killer by Thomas Levy MD, JD. 2006 (16)

Left image courtesy of Thomas Levy Book Cover.

Nutritional Deficiency Disease

Heart Disease is not a Statin Deficiency, it is a Vitamin C Deficiency. and it is all explained in this free booklet by Owen Fonorow.(
18) Or, read this excellent article by English and Cass.(19)

What is the Linus Pauling Protocol?

L-ascorbate (Vitamin C) 5-6 grams a day in divided doses
L-Lysine 5 grams a day in divided doses
L-Proline 2-3 grams a day in divided doses

These can be obtained at any the health food store as tablets or capsules for 40 to 50 dollars a month.  A convenient powder form can be obtained at
Tower Laboratories.  They have a product called Heart-Tech which provide the Linus Pauling Protocol in powder form.  There is also the Vitamin C Foundation Cardio-C.  "Avoid pills with this PAULING THERAPY drink mix. Cardio-C provides 2500 mg vitamin C and 2500 mg lysine per serving plus 500 mg proline." (17)  

For Part Two of this Article, Click Here:
Heart Disease, Ascorbate, Lysine and Linus Pauling by Jeffrey Dach MD

Track Your Plaque by Wilam Davis MD

For heart disease prevention and reversal, I also strongly recommend the Track Your Plaque Program by William Davis MD which is described in these two related articles:

CAT Coronary Calcium Scoring, Reversing Heart Disease by Jeffrey Dach MD

Heart Disease Part Two by Jeffrey Dach MD

Financial Disclosure:  I have no financial interest in Vitamin C Foundation, Tower Labororatories or LivOn Labs, Track Your Plaque, nor do I receive income from the sale of any books mentioned here.

How to Design a better Jupiter study:

1) measure TSH as in the Hunt study. A lower TSH (higher thyroid function) was associated with a 70% reduction in cardiac mortality. 2) Measure Coronary Calcium score baseline and as a response to treatment. 3) Use the Linus Pauling Protocol (Vitamin C and Lysine) for one arm of the study.  My guess is the outcome of this arm would exceed all others.  3) patient selection should include all ages and no washout for adverse effects.  Also include patients that are not obese or overweight, and not pre-diabetic.

Related articles:

Cholesterol Lowering Statin Drugs for Women, Just Say No by Jeffrey Dach MD

Lipitor and The Dracula of Modern Technology by Jeffrey Dach MD

Vitamin C and Stroke Prevention by Jeffrey Dach MD


Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Fl 33021
 954-983-1443 
www.jeffreydach.com
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www.truemedmd.com

(c) 2008 Jeffrey Dach MD All Rights Reserved This article may be reproduced on the internet without permission, provided there is a link to this page and proper credit is given.

Link to this article:
http://jeffreydach.com/2008/11/14/crestor-jupitor-crp-and-heart-attack--by-jefffrey-dach-md.aspx

References and Links:

(
1) http://www.proteinpower.com/drmike/cardiovascular-disease/1853/
Truth versus hype in the Jupiter study Michael R Eades MD

(
2) http://jeffreydach.com/2008/01/27/cholesterol-lowering-statin-drugs-for-women-just-say-no-by-jeffrey-dach-md.aspx
 Cholesterol Lowering Statin Drugs for Women, Just Say No by Jeffrey Dach MD

(
3http://www.health-heart.org/malpractice.pdf
LETTER TO THE EDITOR Statins for women, elderly: Malpractice?
Nutrition, Metabolism & Cardiovascular Diseases (2007) 17, e19ee20
Eddie Vos 

(
4) http://lib.bioinfo.pl/pmid:18952164
Vitamin C treatment reduces elevated C-reactive protein.
Free Radic Biol Med. 2008 Oct 10; : 18952164 Gladys Block, Christopher D Jensen, Tapashi B Dalvi, Edward P Norkus, Mark Hudes, Patricia B Crawford, Nina Holland, Ellen B Fung, Laurie Schumacher, Paul Harmatz University of California, Berkeley, CA 94720, USA.

Plasma C-reactive protein (CRP) is an inflammatory biomarker that predicts cardiovascular disease. Lowering elevated CRP with statins has reduced the incidence of cardiovascular disease. We investigated whether vitamin C or E could reduce CRP.

Healthy nonsmokers (N=396) were randomized to three groups,
1000 mg/day vitamin C, 800 IU/day vitamin E, or placebo, for 2 months. Among participants with CRP indicative of elevated cardiovascular risk (>/=1.0 mg/L), vitamin C reduced the median CRP by 25.3% vs placebo (p=0.02) (median reduction in the vitamin C group, 0.25 mg/L, 16.7%). These effects are similar to those of statins.

(
5) http://www.ncbi.nlm.nih.gov/pubmed/1591317?dopt=Abstract
Vitamin C intake and mortality among a sample of the United States population.
Epidemiology. 1992 May;3(3):194-202.  Enstrom JE, Kanim LE, Klein MA. School of Public Health, University of California, Los Angeles 90024.

We examined the relation between vitamin C intake and mortality in the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study cohort. This cohort is based on a representative sample of 11,348 noninstitutionalized U.S. adults age 25-74 years who were nutritionally examined during 1971-1974 and followed up for mortality (1,809 deaths) through 1984, a median of 10 years.
An index of vitamin C intake has been formed from detailed dietary measurements and use of vitamin supplements.

The relation of the standardized mortality ratio (SMR) for all causes of death to increasing vitamin C intake is strongly inverse for males and weakly inverse for females. Among those with the highest vitamin C intake, males have an SMR (95% confidence interval) of 0.65 (0.52-0.80) for all causes, 0.78 (0.50-1.17) for all cancers, and 0.58 (0.41-0.78) for all cardiovascular diseases; females have an SMR of 0.90 (0.74-1.09) for all causes, 0.86 (0.55-1.27) for all cancers, and 0.75 (0.55-0.99) for all cardiovascular diseases. Comparisons are made relative to all U.S. whites, for whom the SMR is defined to be 1.00.

Vitamin C and cardiovascular disease

(6) http://content.onlinejacc.org/cgi/content/full/42/2/246

J Am Coll Cardiol, 2003; 42:246-252, doi:10.1016/S0735-1097(03)00575-8

Vitamin C and risk of coronary heart disease in women

Stavroula K. Osganian, MD*,*, Meir J. Stampfer, MD||, Eric Rimm, ScD||, Donna Spiegelman, ScD||, Frank B. Hu, MD, JoAnn E. Manson, MD||¶ and Walter C. Willett, MD||

OBJECTIVES: Our objective was to prospectively examine the relation between vitamin C intake and risk of coronary heart disease (CHD) in women.

BACKGROUND: Results from prospective investigations of the relation between vitamin C intake and risk of CHD have been inconsistent. The lack of clear evidence for a protective association despite a plausible mechanism indicates the need to evaluate further the association between vitamin C intake and risk of CHD.

METHODS: In 1980, 85,118 female nurses completed a detailed semiquantitative food-frequency questionnaire that assessed their consumption of vitamin C and other nutrients. Nurses were followed up for 16 years for the development of incident CHD (nonfatal myocardial infarction and fatal CHD).

RESULTS: During 16 years of follow-up (1,240,566 person-years), we identified 1,356 incident cases of CHD. After adjustment for age, smoking, and a variety of other coronary risk factors, we observed a modest significant inverse association between total intake of vitamin C and risk of CHD (relative risk [RR] = 0.73; 95% confidence interval [CI] 0.57 to 0.94). Among women who did not use vitamin C supplements or multivitamins, the association between intake of vitamin C from diet alone and incidence of CHD was weak and not significant (RR = 0.86; 95% CI 0.59 to 1.26). In multivariate models adjusting for age, smoking, and a variety of other coronary risk factors, vitamin C supplement use was associated with a significantly lower risk of CHD (RR = 0.72; 95% CI 0.61 to 0.86).

CONCLUSIONS: Users of vitamin C supplements appear to be at lower risk for CHD. Women in the highest quintile of vitamin C intake (360 mg/day) from diet and supplements had a 27% lower risk of nonfatal MI and fatal CHD than women in the lowest quintile of intake (93 mg/day). The reduction in risk appeared to be limited to women who took vitamin C supplements.  Among users of vitamin C supplements, we observed a significant 28% lower risk of nonfatal MI and fatal CHD than among
non-users. Although risk did not vary significantly according duration of use of supplements or dose of supplements, the reduction in risk was somewhat stronger for women taking at least 400 mg/day.

Sahyoun et al. (16) observed a significantly lower risk of death (62%) from CHD (RR = 0.38; 95% CI 0.19 to 0.75) for those in the highest (>388 mg/day) than for those in the lowest (90 mg/day) quintile of total intake in an elderly population.

The First National Health and Nutrition Examination Study (NHANES I) Epidemiologic Follow-up Study (40) found a 25% lower risk of mortality from all cardiovascular disease (RR = 0.75; 95% CI 0.55 to 0.99) only among women who consumed 50 mg/day or more of vitamin C and took supplements

Adverse Effects of Crestor

(
7) http://www.fda.gov/CDER/Drug/advisory/crestor.htm
FDA Public Health Advisory for Crestor (rosuvastatin)

(8) http://www.fda.gov/cder/drug/infopage/rosuvastatin/crestor_CP.pdf
In 2004, the consumer interest organisation Public Citizen filed a Citizen's Petition with the FDA asking that Crestor be withdrawn from the US market. On March 11, 2005, the FDA issued a letter to Sidney M. Wolfe, M.D. of Public Citizen both denying the petition and providing an extensive detailed analysis of findings which demonstrated no basis for concerns about rosuvastatin compared with the other statins approved for marketing in the United States.[8].

(9) http://www.spacedoc.net/crestor.htm
Crestor Side Effects ( Rosuvastatin )  Dwayne Graveline MD Space Doc.com

(10) http://www.fda.gov/cder/drug/advisory/crestor_3_2005.htm
The “Warnings” and “Dosage and Administration” sections of the label have been revised to more strongly emphasize the risks of myopathy, particularly at the highest approved dose of 40 mg. In order to minimize risks of myopathy and rhabdomyolysis (the most severe form of statin muscle injury), the revised label now explicitly states that the 5 mg dose is available as a start dose for those individuals who do not require aggressive cholesterol reductions or who have predisposing factors for myopathy.
All patients should be informed that statins can cause muscle injury which can lead to renal failure.

(11) http://heartscanblog.blogspot.com/2008/11/can-crp-be-reduced.html
Can CRP be reduced?, the Heart Scan Blog William Davis MD Cardiologist

"If we follow the line of reasoning that prompted this study, reducing CRP may correlate with reduction of cardiovascular events. Thus, in the JUPITER study, Crestor 20 mg per day reduced cardiovascular events by nearly half.

From a CRP perspective, starting values were 4.2 mg/dl in the Crestor group of the trial, 4.3 mg/dl in the placebo group. After 24 months, CRP in the Crestor group was 2.2 mg/dl, 3.5 mg/dl in the placebo group, representing a 37% reduction.

Now, in our Track Your Plaque program--an experience that has yielded the virtual ELIMINATION of cardiovascular events--we aim for a CRP level of 1.0 mg/dl or less, ideally 0.5 mg/dl or less. The majority of people achieve these ambitious levels. In fact, it is a rare person who does not."

(
12) http://practicingmedicinewithoutalicense.com/
Practicing Medicine Without a License by Owen Fonorow.

(
13) http://orthomolecular.org/library/jom/1992/pdf/1992-v07n01-p005.pdf 
Unified Theory of Human Cardiovascular Disease Leading the Way to the Abolition of This Disease as a Cause for Human Mortality (1992) Rath M, Pauling L. Journal of Orthomolecular Medicine, 6: 139-143. Ascorbate deficiency is the precondition and common denominator of human CVD. Ascorbate deficiency is the result of the inability of man to synthesize ascorbate endogenously in combination with insufficient dietary intake.

(
14) http://www.unicityscience.org/images/Files/niedzwieki.pdf
Journal of Applied Nutrition 1996, 48: 67-78.

Nutritional Supplement Program Halts Progression of Early Coronary Atherosclerosis 
Documented by Ultrafast Computed Tomography
Matthias Rath, M.D. and Aleksandra Niedzwiecki, Ph.D.

ABSTRACT: The aim of this study was to determine the effect of a defined nutritional supplement program on the natural progression of coronary artery disease. This nutritional supplement program was composed of vitamins, amino acids, minerals, and trace elements, including a combination of essential nutrients patented for use in the prevention and reversal of cardiovascular disease. The study was designed as a prospective intervention before-after trial over a 12 month period and included 55 outpatients age 44-67 with various stages of coronary heart disease. Changes in the progression of coronary artery calcification before and during the nutritional supplement intervention were determined by Ultrafast Computed Tomography (Ultrafast CT). The natural progression rate of coronary artery calcification before the intervention averaged 44% per year. The progression of coronary artery calcification decreased on average 15% over the course of one year of nutritional supplementation. In a subgroup of patients with early stages of coronary artery disease, a statistically significant decrease occurred, and no further progression of coronary calcification was observed. In individual cases, reversal and complete disappearance of previously existing coronary calcifications were documented. This is the first clinical study documenting the effectiveness of a defined nutritional supplement program in halting early forms of coronary artery disease within one year. The nutritional supplement program tested here should be considered an effective and safe approach to prevention and adjunct therapy of cardiovascular disease.

(
15) http://www.newmediaexplorer.org/chris/5278189.pdf
patent on Linus Pauling Protocol


(
16) http://www.livonlabs.com/cgi-bin/htmlos.cgi/LV/apps/stop-americas-killer.html
2006 Stop America's #1 Killer by Thomas Levy MD, JD

(17) http://vitamincfoundation.org/
Owen Fonorows articles can be found at the Vitamin C Foundation.
Vitamin C Foundation Cardio-C $39.45
Avoid pills with this very good tasting PAULING THERAPY drink mix. Cardio-C provides 2500 mg vitamin C and 2500 mg lysine per serving plus 500 mg proline and the herb stevia. 1 to 2 jars Cardio-C recommended per month

(
18) http://www.internetwks.com/owen/Synopsis.pdf

(19) http://www.nutritionreview.org/library/collagen.connection.html
Linus Pauling's Unified Theory of Human Cardiovascular Disease
The Collagen Connection Jim English and Hyla Cass, MD

Heart Disease and Vitamin C

http://www.hearttechnology.com/

Tower Heart for ordering supplements

http://www.livonlabs.com/
Lypo-SphericTM Vitamin C proven many times more powerful than all other oral forms of Vitamin C

http://www.trackyourplaque.com/
Track Your Plaque

http://jeffreydach.com/2008/03/27/cat-coronary-calcium-scoring-reversing-heart-disease-by-jeffrey-dach-md.aspx
CAT Coronary Calcium Scoring, Reversing Heart Disease by Jeffrey Dach MD

Heart Disease Part Two by Jeffrey Dach MD
http://jeffreydach.com/2008/04/18/heart-disease-part-two-by-jeffrey-dach-md.aspx

http://www.drrathresearch.org/lab_research/study_hd_unified_theory.html 
In this paper we present a unified theory of human CVD. This disease is the direct consequence of the inability of man to synthesize ascorbate in combination with insufficient intake of ascorbate in the modern diet. Since ascorbate deficiency is the common cause of human CVD, ascorbate resupplementation is the universal treatment for this disease. The available epidemiological and clinical evidence is reasonably convincing. Further clinical confirmation of this theory should lead to the abolition of CVD as a cause of human mortality for the present generation and future generations of mankind.

http://www.drrathresearch.org/lab_research/study_hd_solutionpuzzle_cardio.html
Solution to the Puzzle of Human Cardiovascular Disease: Its Primary Cause Is Ascorbate Deficiency, Leading to the Deposition of Lipoprotein(a) and Fibrinogen/Fibrin in the Vascular Wall (1991) Rath M, Pauling L. Journal of Orthomolecular Medicine, 6:125-134.

Summary (Abstract) Human cardiovascular disease (CVD) is the result of the accumulation of lipoprotein(a), Lp(a), rather than of low density lipoprotein (LDL), in the vascular wall. It is generally not the consequence of plasma LDL levels, but rather of the level of Lp(a), which is formed in the liver in amounts largely determined by the rate of synthesis of apo(a). This rate is increased by low ascorbate concentrations. Human CVD is primarily a degenerative disease caused by ascorbate deficiency. This deficiency is the result of the inability of humans to synthesize endogenous ascorbate combined with an insufficient dietary ascorbate intake. The deficiency is aggravated by genetic defects such as the LDL receptor defect and by exogenous risk factors for CVD leading to additional ascorbate depletion. Ascorbate deficiency results in morphologic changes of the vascular wall. In order to avoid the fatal consequences of extreme ascorbate depletion, such as hemorrhagic bleeding in scurvy, ascorbate deficiency simultaneously increases the plasma concentration of vasoconstrictive and hemostatic risk factors, including Lp(a) and fibrinogen. Chronic ascorbate deficiency leads to the extracellular accumulation of Lp(a) and fibrinogen/fibrin, the hallmarks of the atherosclerotic lesion. The underlying impairment of the vessel wall is unmasked mainly at sites of altered hemodynamic conditions, leading to myocardial infarction and stroke as the predominant manifestations of human CVD. T

hus for patients with coronary or cerebrovascular disease the instability of the vessel wall due to ascorbate deficiency is the leading risk factor, rather than plasma constituents. In contrast, risk factors in plasma trigger the manifestation of peripheral vascular disease (PVD). In this condition plasma constituent such as oxygen free radicals from cigarette smoke or oxidatively modified triglyceride-rich lipoproteins exert a noxious effect on the vascular wall in the periphery and PVD develops. Ascorbate depletion of the vascular tissue is also a precondition for the manifestation of PVD. Human CVD is multifactorial. Ascorbate deficiency, however, is the common denominator of this disease. The comprehensive pathogenetic and therapeutic concept presented in this paper represents the solution to the puzzle of human cardiovascular disease and should lead to the improvement of human health

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=54501
Proc Natl Acad Sci U S A. 1990 August; 87(16): 6204–6207.  PMCID: PMC54501 Hypothesis: lipoprotein(a) is a surrogate for ascorbate.  M Rath and L Pauling Linus Pauling Institute of Science and Medicine, Palo Alto, CA 94306.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=55170
Proc Natl Acad Sci U S A. 1990 December; 87(23): 9388–9390.  PMCID: PMC55170  Immunological evidence for the accumulation of lipoprotein(a) in the atherosclerotic lesion of the hypoascorbemic guinea pig. M Rath and L Pauling Linus Pauling Institute of Science and Medicine, Palo Alto, CA 94306-2025.

Lipoprotein(a) [Lp(a)] is an extremely atherogenic lipoprotein. Lp(a) has been found in the plasma of humans and other primates, but until now only in a few other species.
The mechanism by which it exerts its atherogenicity is still poorly understood.
We observed that Lp(a) has been found in the plasma of several species unable to synthesize ascorbate and not in other species. We have now detected apoprotein(a) in the plasma of the guinea pig.

We induced atherosclerosis in this animal by dietary ascorbate depletion and, using SDS/PAGE and subsequent immunoblotting, we identified Lp(a) as accumulating in the atherosclerotic plaque.

Most importantly, adequate amounts of ascorbate (40 mg per kg of body weight per day) prevent the development of atherosclerotic lesions in this animal model and the accumulation of Lp(a) in the arterial wall.

We suggest an analogous mechanism in humans because of the similarity between guinea pigs and humans with respect to both the lack of endogenous ascorbate production and the role of Lp(a) in human atherosclerosis.

================================
http://www.rath-eduserv.com/english/health/uk_studies09.html

EUROPEAN HEART JOURNAL (1990) 11 (SUPPL. E), 174-183
Lipoprotein (a) in the arterial wall U. Beisiegel, A. Niendorf, K. Wolf, T. Reblin and M. Rath

We compared CHD patients with healthy blood donors to confirm the role of Lp(a) as an independent risk factor. More important, we performed biochemical and immunohistochemical studies to evaluate the potential mechanism by which Lp(a) causes CHD. We measured the Lp(a) concentration in comparison with other lipoprotein parameters in fresh human arterial wall biopsies and, in autopsy tissue, we localized apo (a) and apo B, as well as fibrin,  with immunohistochemical methods in different vessel areas.

Density gradient ultracentrifugation was used to analyze lipoprotein fractions isolated from human arterial wall. Lp(a) accumulates in the intima, preferentially in plaque areas, dependent on the serum Lp(a) level. Most of the Lp(a) can be located extracellularly, but apo (a) can also be detected in foam cells.

http://www.rath-eduserv.com/english/health/uk_studies15.html

http://www.saveyourheart.com/historyofthenutritionalcure_heartdiseasehealth.html
Arterial Plaque, Blood Pressure, Cholesterol  Ray Ellis
A Short History of the Nutritional Approach to the Prevention and Cure of Cardiovascular Disease

This essay is a condensation of my "book in progress" entitled A Nutritional Approach to the Prevention and Cure of Cardiovascular Disease. It details the creation of the Pauling Therapy, an innovative approach to the treatment of coronary artery disease. It is my hope that this will provide you with further information, such as the cause of plaque in arteries, and why my method for cholesterol reduction works.

http://diabetesupdate.blogspot.com/2008/11/should-you-be-taking-statin-what.html
Should You be Taking a Statin? What the Crestor Study Really Found.  
A new study has been reported all over the media as proving that just about everyone should be taking Crestor because of the way it lowered the incidence of stroke and heart attack. by Jenny Ruhl

http://high-fat-nutrition.blogspot.com/2008/11/cholesterol-heart-attacks-and-jupiter.html
Hyperlipid,  Cholesterol, heart attacks and JUPITER
 
There was a snippet on Radio 4 about the JUPTER study this morning. It was basically an ad for statins for everyone in the UK. Well, 75% of the adult population.

http://junkfoodscience.blogspot.com/2008/11/when-news-sounds-too-good-statins-new.html
Junk Food Science November 10, 2008
When the news sounds too good… statin, the new wonder drug

http://thehealthyskeptic.org/preventing-heart-disease-without-drugs/
More statin shenanigans

http://www.darkgovernment.com/news/pharmaceuticals-push-dangerous-statins/
Pharmaceuticals Push Dangerous Statins

http://naturalhealthnews.blogspot.com/2008/11/and-now-for-rest-of-story.html
Thursday, November 13, 2008
And Now for the Rest of the Story, Just this past Sunday (9 November, 2008) I posted this article on Natural Health News: Boosting Drug Sales with Studies.

http://www.gooznews.com/archives/001243.html
CRP -- The Next Chapter in Medical Waste? Gooz News

First let's take a look at these "apparently" healthy people (men over 50 and women over 60). The median body mass index for the group was 28.3, which means more than half were significantly overweight. Indeed, a third were categorized as obese, which isn't surprising since 41 percent had metabolic syndrome, a suite of conditions that suggests the person is well down the road to developing Type II diabetes.

Cardiovascular incidents fell from 2.8 percent to 1.6 percent by giving the statin, the number of so-called hard events -- heart attacks and strokes, including those that were fatal -- fell from 1.7 percent in the placebo group to 0.9 percent in the statin group, a drop of eight-tenths of a percentage point.  In other words, for every person who didn't get a serious cardiovascular event, three-quarters of a person got diabetes.

120 patients had to be treated for 1.9 years to prevent one serious cardiac event. $1,250 a year x 120 pts. That's $285,000 per event prevented just for the statin pills.

http://www.drmcdougall.com/misc/2008other/news081110crestor.html
John McDougall McDougall Wellness Center  http://www.drmcdougall.com

Advertising Passed Off As Research Confuses the Public Again

One More Deregulated System That Must Be Fixed

Neither the patient nor our over-burdened health care system can thrive with this kind of deception from the pharmaceutical companies and the medical journals.  Fortunately, health care professionals are beginning to recognize that what is happening in medical care is just like the tragedies we have recently witnessed in the stock market and the housing industries.  Unregulated business practices lead to a few very rich people becoming even richer, and severe suffering for the rest of us.  The time has come for change.  Researchers and publishers must be held accountable like stockbrokers and bankers.  Regulation enacted to protect the public is long overdue.

http://www.pharmalot.com/2008/11/will-the-crestor-study-sell-more-cholesterol-pills/
Will The Crestor Study Sell More Cholesterol Pills? Ed Silverman Pharmalot

http://www.pharmalot.com/2008/11/the-crestor-study-tells-us-mark-zucker-explains/

By Ed Silverman // November 10th, 2008 // 4:53 pm

We chatted with Mark Zucker, a heart treatment specialist at the St. Barnabas Health Care System and president of the American College of Cardiology’s New Jersey chapter:

Pharmalot: What did the study tell you?

Zucker: It’s not unknown in the medical community that statins decrease inflammation. Therefore, the idea that statins might lower CRP isn’t at all surprising…What is surprising and reassuring is that we saw an effect in a relatively short period of time…It also suggests that our general sense, in the past, the the benefits of statins extend beyond their cholesterol-lowering effects is probably correct…In the short run the impact may be hard to asses, but in the long run, the study may have a profound impact on how we treat patients and shifts the paradigm from treatment to prevention.

Pharmalot: Well, should everyone be tested for CRP?
Zucker: CRP is certainly a strong predictor of additional risk above and beyond cholesterol and LDL. For that reason, it is not unreasonable to screen patients for CRP elevations at least once during their 40’s or early 50’s.

Pharmalot: Should statins now be given to people with high CRP and low LDL?
Zucker: That’s the crux of the study - what to do with patients with elevated CRP and acceptable LDL? Let’s first keep in mind that the target level of total cholesterol and LDL is somewhat arbitrary. We accept 70 mg/dl as the target, but in agrarian societies and in newborns, the LDL is generally less than 50 to 60 mg/dl. So, in reality it is unclear if the LDL in these patients was optimal. It probably wasn’t. It was just not particularly elevated by our standard. If you do choose to prescribe statins more liberally, this study provides at least some preliminary data to support your position. Nevertheless, putting patients on a statin to lower the CRP is certainly not an approved indication and does place the physician at some risk. At a minimum, one ought to recheck the CRP after three to six months of treatment just to ensure that the desired effect was achieved, otherwise, you might as well discontinue it until more data is available.

Pharmalot: Should Crestor be widely prescribed? And what about other statins?
Zucker: A few points need to be considered. First, Crestor was the only drug studied. Second, it is the single most potent statin on the market. Third, Crestor it is expensive and it is not available as a generic. The cost treating the over 7 million Americans who might fall into the Jupiter cohort would be measured in the billions of dollars. Admittedly, upfront costs may save costs downstream by preventing CAD, CHF and CVA’s. Unfortunately, it’s a very hard analysis to perform. Certainly, the costs would be less if generically available statins had the same effect. This is not known and it is not good science or medicine to assume that all members of the class of statins will likewise decrease CRP. It may be true, but this is as yet unproven. From my point of view, additional studies will need to be done with other statins before recommending widespread use of Crestor or any of the sister statins

Doug Bremner November 10th, 2008 8:23 pm

The study excluded subjects with diabetes or hypertension and
there was a four week “placebo” run in phase and subjects who were not compliant during that phase were dropped. 80% of the patients were excluded and many more were excluded during the placebo run in phase. What this means for the regular patient is unknown.

The reduction in total mortality was 1.0 per 100 patient years versus 1.25 in the placebo group, a difference of 25% in relative risk, but of 0.25% in absolute risk (i.e. not that great). I think one thing this study highlights is that maybe LDL reduction is not the “cause” of risk reduction, or at least exclusively.

The relative risk v absolute risk distinction is critical. (the cardiology research community has been moving toward the inflammatory pathways area for several years now; elevated CRP is probably associated with the metabolic syndrome, etc).

Blog Reactions to Jupiter

http://livingto150.com/statins-dont-be-fooled-by-the-research/

Statins - Don’t Be Fooled By The Research

http://robertscottbell.blogspot.com/2008/11/white-washing-crestor-statin-drugs.html

http://www.emaxhealth.com/1/107/26319/media-hype-over-crestor-may-be-hazardous-your-health.html

http://naturalhealthnews.blogspot.com/2008/11/boosting-drug-sales-with-studies.html

http://www.medicationsense.com/articles/may_aug_05/crestor_headlines_053005.html

_________________________________________________

http://circ.ahajournals.org/cgi/content/abstract/112/1/25
CRP (Circulation. 2005;112:25-31.)

C-Reactive Protein and the 10-Year Incidence of Coronary Heart Disease in Older Men and Women  The Cardiovascular Health Study

Mary Cushman, MD, MSc; Alice M. Arnold, PhD; Bruce M. Psaty, MD, PhD; Teri A. Manolio, MD, PhD; Lewis H. Kuller, MD, DrPh; Gregory L. Burke, MD, MS; Joseph F. Polak, MD, MPH; Russell P. Tracy, PhD From the Departments of Medicine and Pathology

The population-attributable risk of CHD for elevated CRP was 11%.
Risk relationships did not differ in subgroups defined by baseline risk factors.
We assessed whether CRP improved prediction by the Framingham Risk Score.
Among men with a 10-year Framingham-predicted risk of 10% to 20%, the observed
CHD incidence was 32% for elevated CRP. Among women, CRP discriminated best among those with a 10-year predicted risk >20%; the incidences were 31% and 10% for elevated and normal CRP levels, respectively.

CRP study

http://www.medpagetoday.com/Cardiology/Dyslipidemia/277
Statins May Impact Heart Disease by Lowering CRP levels Independently of Lowering Cholesterol By Margie Patlak, Published: January 06, 2005

reducing CRP

http://heartdisease.about.com/od/cardiacriskfactors/a/highCRP.htm
What To Do When Your CRP Is High Ok, your CRP level is high. Now what?
By Richard N. Fogoros, M.D., About.com Updated: November 10, 2008

Vitamin C to reduce CRP

http://www.prohealth.com/library/showarticle.cfm?id=5584&t=CFIDS_FM
Vitamin C Can Reduce C-Reactive Protein -
A Marker of Inflammation & Chronic Disease [Fibromyalgia & Chronic Fatigue Syndrome News] April 14, 2004

Vitamin C can reduce levels of C-reactive protein, a marker of inflammation and chronic disease By: News-Medical Vitamin C supplements can reduce levels of C-reactive protein, a marker of inflammation and chronic disease risk in humans, according to a new study led by researchers at the University of California, Berkeley.

Participants who took about 500 milligrams of vitamin C supplements per day saw a 24 percent drop in plasma C-reactive protein (CRP) levels after two months. The study, published in the April issue of the Journal of the American College of Nutrition, is the first time vitamin C has been shown to decrease levels of CRP, a biomarker that has garnered increasing attention among health researchers in recent years. "C-reactive protein is a marker of inflammation, and there is a growing body of evidence that chronic inflammation is linked to an increased risk of heart disease, diabetes and even Alzheimer's disease," said Gladys Block, UC Berkeley professor of epidemiology and public health nutrition and lead author of the study.

http://berkeley.edu/news/media/releases/2004/04/12_vitc.shtml

http://www.jacn.org/cgi/content/abstract/23/2/141

Journal of the American College of Nutrition, Vol. 23, No. 2, 141-147 (2004)

Plasma C-Reactive Protein Concentrations in Active and Passive Smokers: Influence of Antioxidant Supplementation Gladys Block, PhD,

Objective: C-reactive protein (CRP) may directly affect the progression of atherosclerosis, and therefore, may be a target for reducing disease risk. The objective was to determine whether antioxidant supplementation reduces plasma CRP in active and passive smokers.

Design: Randomized, double-blind, placebo-controlled, parallel group trial with 2 months exposure to study supplements.

Subjects: Healthy adult men and women, consuming <4 daily servings of fruits and vegetables, and who were actively or passively exposed to cigarette smoke. Analysis was limited to participants with detectable baseline CRP concentrations and no evidence of inflammation associated with acute illness at baseline or follow-up as reflected in CRP elevations (10.0 mg/L). A total of 1393 individuals were screened, 216 randomized, 203 completed the study, and 160 were included in the analysis.

Interventions: Participants were randomized to receive a placebo or vitamin C (515 mg/day) or antioxidant mixture (per day: 515 mg vitamin C, 371 mg -tocopherol, 171 mg -tocopherol, 252 mg mixed tocotrienols, and 95 mg -lipoic acid).

Measures of Outcome: Change in plasma CRP concentration.

Results: Vitamin C supplementation yielded a 24.0% reduction (95% confidence interval, -38.9% to -5.5%, p = 0.036 compared to control) in plasma CRP, whereas the antioxidant mixture and placebo produced a nonsignificant 4.7% reduction (-23.9% to 19.3%) and 4.3% increase (-15.1% to 28.2%), respectively. Results were adjusted for baseline body mass index and CRP concentrations.

Conclusions: Plasma CRP itself may serve as a potential target for reducing the risk of atherosclerosis, and antioxidants, including vitamin C, should be investigated further to confirm their CRP-lowering and anti-inflammatory effects.

Fiber to reduce CRP

http://www.medscape.com/viewarticle/553590

High-Fiber Diets, Fiber Supplements Reduce CRP Levels 
News Author: Shelley Wood CME Author: Hien T. Nghiem, MD

Overall, the mean CRP level changed from 4.4 to 3.8 mg/L (-13.7%; P = .046) in the high-fiber DASH diet group and to 3.6 mg/L (-18.1%) in the fiber-supplemented diet group (P = .02).

reducing crp naturally

http://www.life-enhancement.com/article_template.asp?ID=936
Multivitamins Reduce Risk for Heart Disease and Diabetes Vitamins B6, C, and E are associated with lower levels of CRP, a marker of systemic inflammation
By Dr. Edward R. Rosick

http://www.vrp.com/articles.aspx?ProdID=art1130&zTYPE=2
CRP Biomarker and Cardiovascular Risk Factor-What to do About It
By Ward Dean, M.D.

-------------------------------------------------------------------------------

(membership required)
http://www.trackyourplaque.com/library/fl_01-011crp.asp 
C-Reactive Protein: The Track Your Plaque Perspective

Paul Ridker, MD Harvard University
First of all, what is CRP?

High C-reactive protein (>0.5 mg/l) suggests that inflammation may be a contributor to growth of coronary atherosclerotic plaque. Dr. Paul Ridker of Harvard University, the nation’s authority on CRP, has shown that high CRP levels (of 3 mg/l) increase heart attack risk 3-fold, even when LDL cholesterol is low (Everett BM et al 2006; Tsimikas S et al 2006). When elevated CRP occurs in the company of small LDL particles, heart attack risk is 7-fold greater (St-Pierre AC et al 2003).

Predictably, drug manufacturers have tried to persuade us that the only effective way to reduce CRP is with statin drugs, which reduce CRP from 20–50% (Deveraj S et al 2007). This is simply not true: there are many ways to reduce CRP as well as, or even more effectively, than the statin drugs.

How to Reduce CRP
Weight loss, Choose low-glycemic index,
Exercise,
Nutritional supplements that reduce inflammation:

Omega-3 fatty acids—CRP reductions of approximately 30% are generally achieved (Ciubotaru I et al 2003).

Flavonoids (citrus, blueberries, raspberries, plums, pomegranates, etc.) and vegetables (spinach, dark lettuces, green peppers, red peppers, etc.), red wine (southern French and Italian wines are the most plentiful sources), cocoa (dark chocolate), and green tea (Vayalil PK et al 2004; Kaszkin M et al 2004; Oak MH et al 2004; Tate P et al 2004).

Vitamin D—Supplementation can be among the most potent anti-inflammatory strategies available, reducing CRP dramatically.

Fibers—Healthy fibers, particularly raw almonds, walnuts, oat bran, wheat germ, ground flaxseed, and green vegetable sources, are easy and powerful suppressors of inflammation (Jenkins DJ et al 2005).

Drugs that lower inflammation

Statin cholesterol drugs—Statin drugs are indeed an effective means to reduce C-reactive protein 30–50% over several months.

Aspirin— lowers C-reactive protein modestly, usually no more than 15% (Prasad K et al 2006).

Lifestyle strategies and supplements, particularly fish oil and vitamin D, are the cornerstones of your nutritional supplements to reduce inflammation.  

http://www.trackyourplaque.com/library/fl_06-002inflammation1.asp
Extinguishing Inflammation: A Practical Guide
Part 1: Why inflammation is important in health
http://www.trackyourplaque.com/library/fl_06-002inflammation2.asp

------------

http://content.nejm.org/cgi/content/full/NEJMoa0807646
 
November 9, 2008 Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein.  Paul M Ridker, M.D.,  for the JUPITER Study Group

http://content.nejm.org/cgi/content/full/NEJMe0808320
editorial on Jupiter study
----------------

http://www.theheart.org/article/914925.do
Genetic study undermines case for CRP as cause of vascular disease

Gregory A. Plotnikoff: What price prevention? By GREGORY A. PLOTNIKOFF   Star Tribune Minneapolis St Paul. Last update: November 11, 2008 - 7:33 PM

Regarding the Tuesday editorial on the study of the benefits of the heart drug Crestor: Overall, the study found 83 heart attacks, strokes and deaths from cardiac causes among the 8,901 patients given Crestor, compared with 157 in the equal number getting a placebo. That means 120 people would need to be treated for two years at $3.45 a day per person to prevent just one cardiac event.  The total cost for the 120 people to prevent the one heart attack? It's $300,000. This data is what the head of cardiology at the Cleveland Clinic called an "out-of-the park home run."

http://uk.youtube.com/watch?v=VmBnaJIQdUw
CNBC Host Recommends Statins be Put in the Water Supply
Squack Box: Wants CRP to become part of the American LExicon. Statins can save thousands.

People with normal cholesterol and high CRP, good predictor of hert attack risk.  Crp dropped, risk of heart attack cut in half.  Paul Ridker lead author, holds patent on CRP test, ($20), easy way to dramatically lower risk.  Could prompt millions more americans to be ut on statins.  Steve Nisson, its a very larg reduction in heart attacks and strkes and need for procedures in a group of people that we would otherwise never treat.
Other announcer Questions the cholesterol theory of heart disease.  Its not cholesterol, its inflammation.

http://circ.ahajournals.org/cgi/content/full/99/6/733
Lyons Diet Omega 3 (Circulation. 1999;99:733-735.) Editorials
Dietary Prevention of Coronary Heart Disease The Lyon Diet Heart Study
Alexander Leaf, MD From the Departments of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston.

Despite the striking findings in the first report of a 70% reduction in all-cause mortality due to a reduction in coronary heart disease (CHD) mortality and comparable large reductions in nonfatal sequelae, I have encountered few cardiologists here who are aware of that study

Let me quote from once the top man at Mass. General Hosp, and Harvard’s medical department, Alex Leaf, in Circ. about omega-3’s, : “…relatively simple dietary changes achieved greater reductions in risk of all-cause and coronary heart disease mortality [deaths that is] .. than any of the cholesterol-lowering studies to date. This is emphasized by the finding that the unprecedented reduction … was not associated with differences in total cholesterol.” Source:

Vitamin C and CRP
http://www.sciencedaily.com/releases/2008/11/081113091630.htm

http://www.berkeley.edu/news/media/releases/2008/11/12_vitaminc.shtml
Press Release  Vitamin C lowers levels of heart disease biomarker, finds study, adds to debate of health benefits By Sarah Yang, Media Relations | 12 November 2008

The study led by Block, currently online and scheduled to appear in the Jan. 1 issue of the journal Free Radical Biology and Medicine, shows that for healthy, non-smoking adults with an elevated level of CRP, a daily dose of vitamin C lowered levels of the inflammation biomarker after two months compared with those who took a placebo. However, participants who did not start out with elevated CRP levels saw no benefit from vitamin C supplementation.

"This is an important distinction; treatment with vitamin C is ineffective in persons whose levels of CRP are less than 1 milligram per liter, but very effective for those with higher levels," said Block. "Grouping people with elevated CRP levels with those who have lower levels can mask the effects of vitamin C. Common sense suggests, and our study confirms, that biomarkers are only likely to be reduced if they are not already low."

The researchers said that for people with elevated CRP levels, the amount of CRP reduction achieved by taking vitamin C supplements in this study is comparable to that in many other studies of cholesterol-lowering drugs called statins. They noted that several larger statin trials lowered CRP levels by about 0.2 milligrams per liter; in this latest study, vitamin C lowered CRP by 0.25 milligrams per liter.

"This finding of an effect of vitamin C is important because it shows in a carefully conducted randomized, controlled trial that for people with moderately elevated levels of inflammation, vitamin C may be able to reduce CRP as much as statins have done in other studies," said Block.

Evidence of the link between elevated CRP levels and a greater risk of heart disease has grown in recent years, but it had been unclear whether the beneficial effects of lowering CRP were independent of the effects of lowering cholesterol.

Newly released results from a multinational clinical trial help answer that question. Led by researchers at Harvard Medical School, the study, known as the Jupiter trial, found that statins reduced cardiovascular mortality and morbidity among people whose cholesterol levels were normal, but whose levels of CRP were greater than 2 milligrams per liter. The Jupiter trial found that among people who had such high levels of CRP at baseline, levels of CRP were 37 percent lower with statins compared with a placebo.

"One of the strengths of the Jupiter trial is that only persons with CRP levels greater than 2 milligrams per liter were enrolled," Block added. "Researchers found very important effects of lowering CRP in people who had high levels to begin with."

In the UC Berkeley study on vitamin C, participants who started out with CRP levels greater than 2 milligrams per liter had 34 percent lower levels of CRP with vitamin C compared with a placebo.

The UC Berkeley study also found a strong link between obesity and elevated levels of CRP. The researchers found that while 25 percent of normal-weight people had elevated levels of CRP, those levels were found in 50 percent of overweight and 75 percent of obese participants.

"The low-grade inflammation that characterizes obesity is believed to contribute to a number of disorders, including atherosclerosis and insulin resistance," said Nina Holland, adjunct professor at UC Berkeley's Division of Environmental Health Sciences and co-investigator on the study. Holland's biorepository at UC Berkeley processed and stored the thousands of blood samples involved in this study.

ttp://www.cmaj.ca/cgi/content/full/173/10/1207-a

CMAJ • November 8, 2005; 173 (10). doi:10.1503/cmaj.1050120. Letters
Questioning the benefits of statins Eddie Vos* and Colin P. Rose

http://thinking-is-dangerous.blogspot.com/2008/11/lies-damn-lies-and-statins.html
In real, proper, everyday terms, this means that if I have normal cholesterol levels, but higher c-reactive protein levels, over 2 years:-- My risk of heart attack goes from a rather disappointingly low 0.76% to an indistinguishably lower 0.35%.

Alec Elliott said...
Point well taken indeed: how come the authors do not mention ABSOLUTE risk reduction ? 
They are less than 1% !
You do notice death reduction is significant (18000 patients makes it easier) but is it relevant (0.5%)?

The early stoppage has no justification even pre-planned, since the placebo group patients were not harmed by treatment and it is hardly justified to decide they should all be statin treated based on just one study. It is a short time to detect potential more relevant benefits (beyond 1% in absolute risk) or late side effets (mental status deterioration and cancer require a little more time to appear).

One first point makes me feel uncomfortable:
The way the authors naively try and conceal the fact there is no difference in FATAL strokes or myocardial infarction in table 3 : this is ridiculous , anyone can make the maths. This is lousy data presentation spinning. Why should they do that?

---------------
CRP not the cause of heart disease
http://www.theheart.org/article/914925.do
Genetic study undermines case for CRP as cause of vascular disease
October 29, 2008 | Steve Stiles
Copenhagen, Denmark- Is C-reactive protein (CRP) a promoter of cardiovascular disease or simply a marker of increased cardiovascular risk? Probably the latter, according to the latest study to address the question, in which four gene variants tied to sharply increased CRP levels were shown not to be associated with an elevated CV-event risk [1].

"This finding suggests that the increase in the risk of ischemic vascular disease associated with higher plasma CRP levels observed in epidemiologic studies may not be causal, but rather that increased CRP levels are simply a marker for atherosclerosis and ischemic vascular disease," write the authors, led by Dr Jeppe Zacho (Herlev Hospital, Copenhagen, Denmark).

Their research, based on tens of thousands of predominantly community-based participants from four distinct Danish cohort studies, appears in the October 30, 2008 issue of the New England Journal of Medicine.

http://www.badscience.net/2008/11/you-are-80-less-likely-to-die-from-a-meteor-landing-on-your-head-if-you-wear-a-bicycle-helmet-all-day/
goldacre Bad Science

However, my point still stands - The Media, and let's not forget Astra Zeneca themselves - (bless them) will go for the big numbers and the huge claims and to hell with context - but then 'New Study Reduced Risk of Heart Attack from 0.76% to 0.35% for only some people' won't set the media world on fire.

Heart attacks were cut by 54 per cent, strokes by 48 per cent and the need for angioplasty or bypass by 46 per cent among the group on Crestor compared to those taking a placebo or dummy pill”, said the Daily Mail. Dramatic stuff. And in the Guardian, we said: “Researchers found that in the group taking the drug, heart attack risk was down by 54% and stroke by 48%”.

Is this true? Yes. Those are the figures on risk, expressed as something called the “Relative Risk Reduction“. It is the biggest possible number for expressing the change in risk. But 54% lower than what? This was a trial looking at whether it is worth taking a statin if you are at low risk of a heart attack (or a stroke), as a preventive measure: it is a huge market – normal people – but these are also people whose baseline risk is already very low.

If you express the exact same risks from the same trial as an “Absolute Risk Reduction“, suddenly they look a bit less exciting. On placebo, your risk of a heart attack in the trial was 0.37 events per 100 person years, and if you were taking rosuvastatin, it fell to 0.17 events per 100 person years. 0.37 to 0.17. Woohoo. And you have to take a pill every day. And it might have side effects.

The early stoppage has no justification even pre-planned, since the placebo group patients were not harmed by treatment and it is hardly justified to decide they should all be statin treated based on just one study. It is a short time to detect potential more relevant benefits (beyond 1% in absolute risk) or late side effets (mental status deterioration and cancer require a little more time to appear).

One first point makes me feel uncomfortable:
The way the authors naively try and conceal the fact there is no difference in FATAL strokes or myocardial infarction in table 3 : this is ridiculous , anyone can make the maths. This is lousy data presentation spinning. Why should they do that?

Another point:
More diabetes cases, but the authors try and minimise this, stating
"minimal difference in the median glycated hemoglobin value (5.9% and 5.8%, respectively;P = 0.001)." So when that does not suit you , a significant result is tagged "minimal" ; And indeed it is minimal. They say mean glucose was not difference. But this and the glycated hemoglobin level are irrelevant to the matter of diabets. Diabetes is a qualitative diagnosis, you are or you are not diabetic. The elevated glyc. haemoglobin or glucose levels from the diabetes diagnoses are very unlikely to impact on the average values for the group. I also call this a dishonest presentation.

Hence I see in this paper where a lot of money (incentives) are at stake, some indications of a biased presentation.  In essence: why are they trying to make it look better than it does, why this make up ?

Now I acknowledge there are some significant results, but :

1- When I calculate the absolute risks (that they don't indicate, why ? ) I see nothing impressive , less than 1% reductions if I'm not mistaken (absolute risk is real life, relative risk is well known and shamefully accepted in great journals as a way to enhance a result's appearance). Someone is trying to impress us. If they don't give the absolute risk then they are not satisfied with it, this is the logical conclusion.

2- When I read there aren't more muscle complaints with the statin, I am amazed. Really ? Is this consistant with what is previously known? No. Then there may be something wrong. It is not a low dose of rosuvastatin.

3 -When I compare this with the benefits of a healthy way of life (real Cretan diet or equivalent, not just olive oil, physical activity, not smoking) well I don't exactly remember the figures but (I don't have the figures to hand, so I hope I'm not wrong) if I remember well the order of magnitude of the benefits is much higher for no or little cost and extended benefits (bones, cancer , weight, glucose tolerance). This should have been mentionned in the discussion.

4- My opinion on the early interim analysis is that it was unwarranted as stated above, and it feels lik a gambler who leaves the table early after a lucky hand. With more time, the results could have been more convincing with better improvements in absolute risk . With less time there is a lesser risk side effects such as cancer od cognitive decline may be detected.

It is a pity and in my opinion, unethical, that this study was not carried out longer.
This and the aforementionned reasons, and specifically the author's trying to make things look better than they actually are, this makes me feel someone is trying to manipulate me. This casts huge doubts on the study.
And this adds to the fact that at least one authpor has a direct financial interest in selling the CRP test (he has a patent on ot) that discriminates those who "benefit" from treatment. Many authors have significant conflicts of interest. Look up the long list.

- My risk of stroke goes from a most decidedly non-headline-grabbing 0.72% to a yippee-I'm-gonna-live-forever 0.37%.

*Sutton, Que.; Cardiologist, McGill University, Montréal, Que.

----------------------
http://www.health-heart.org/malpractice.pdf
LETTER TO THE EDITOR Statins for women, elderly: Malpractice?
Nutrition, Metabolism & Cardiovascular Diseases (2007) 17, e19ee20
Eddie Vos

http://lib.bioinfo.pl/pmid:18952164

Free Radic Biol Med. 2008 Oct 10; : 18952164 (P,S,G,E,B,D) Vitamin C treatment reduces elevated C-reactive protein.
 
Gladys Block, Christopher D Jensen, Tapashi B Dalvi, Edward P Norkus, Mark Hudes, Patricia B Crawford, Nina Holland, Ellen B Fung, Laurie Schumacher, Paul Harmatz University of California, Berkeley, CA 94720, USA.

Plasma C-reactive protein (CRP) is an inflammatory biomarker that predicts cardiovascular disease. Lowering elevated CRP with statins has reduced the incidence of cardiovascular disease. We investigated whether vitamin C or E could reduce CRP.

Healthy nonsmokers (N=396) were randomized to three groups,
1000 mg/day vitamin C, 800 IU/day vitamin E, or placebo, for 2 months.

Median baseline CRP was low, 0.85 mg/L. No treatment effect was seen when all participants were included. However, a significant interaction was found, indicating that treatment effect depends on baseline CRP concentration.

Among participants with CRP indicative of elevated cardiovascular risk (>/=1.0 mg/L), vitamin C reduced the median CRP by 25.3% vs placebo (p=0.02) (median reduction in the vitamin C group, 0.25 mg/L, 16.7%). These effects are similar to those of statins.

Colbert—or should we say Dr. Colbert?—reviewed the results of the JUPITER trial last night in the latest installment of “Cheating Death with Dr. Stephen T. Colbert, DFA.” That trial, you may recall, suggested that even people with normal cholesterol levels may benefit from the drug Crestor (rosuvastatin), if their C-reactive protein (CRP) levels (inflammation markers) were high.

Comedy Central Cheating Death Report by Colbert: 

Colbert report covers womens Hormones, and Crestor Statin Drug Study

 


Jeffrey Dach MD 4700 Sheridan Suite T Hollywood Fl 33021 954-983-1443
www.jeffreydach.com www.drdach.com www.naturalmedicine101.com www.truemedmd.com

(c) 2008,2009,2010 Jeffrey Dach MD All Rights Reserved This article may be reproduced on the internet without permission, provided there is a link to this page and proper credit is given.

Link to this article:
http://jeffreydach.com/2008/11/14/crestor-jupitor-crp-and-heart-attack--by-jefffrey-dach-md.aspx

 
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