Breakthrough in Preventing Cardiovascular Disease
News of Note (November 17, 2008) — Ten years ago, physician scientists under the leadership of Dr. James T. Willerson, President and Medical Director of the Texas Heart Institute at St. Luke’s Episcopal Hospital (THI at SLEH), and Dr. Ed Yeh, Chief of Cardiology at The University of Texas M. D. Anderson Cancer Center and research leader at THI began testing patients’ blood levels for C-reactive protein (CRP) as a marker of inflammation and determining CRP’s effect on endothelial cells that line the inside of arteries. They determined that CRP promotes the expression of certain adhesive molecules on human endothelial cells that attract circulating cells that cause inflammation in human arteries. When the inflammatory cells attach themselves to the endothelial cells, they promote inflammation and the accumulation of substances that may subsequently cause the buildup and rupturing of dangerous plaques, which is the major cause of heart attacks and strokes. Efforts began immediately to determine ways to interrupt this process.
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| Drs. Edward Yeh and James Willerson. |
One of the largest clinical trials of a cholesterol-lowering drug ever conducted has ended early after dramatic reductions in the risk of heart attack, stroke and death were seen in treated patients. The JUPITER Trial produced commanding evidence that elevated CRP blood levels in seemingly healthy people with relatively normal “bad” cholesterol (LDL) values identifies patients with increased risk of heart attack, stroke and cardiovascular death, and treating these individuals with a potent statin markedly reduces their risk of heart attack, stroke and cardiovascular death.
Approximately 17,000 patients, recruited from 26 countries, were entered into this randomized and placebo-controlled clinical trial. All were apparently healthy, but all had high levels of circulating CRP, the inflammation marker linked to heart disease. The plan was to follow the patients for five years, but the benefits were so compelling that an independent panel of scientists monitoring the results halted the study after only two years.
The results of the JUPITER Trial were presented at the annual meeting of the American Heart Association in New Orleans, Louisiana, on Monday, November 10, 2008, and were published online by the New England Journal of Medicine. The full article describing the trial and its results will be published in the November 20, 2008, issue of the New England Journal of Medicine. Heart attack risk was reduced by 54 percent and stroke by 48 percent in the statin-treated patients. The combined risk of heart attack, stroke and heart-related death fell by 47 percent, as did the odds of undergoing future surgical procedures.
Dr. Willerson, who helped lead the study as a member of the Steering Committee, said, “This is a very gratifying result for patients, and a validation of the work that Dr. Ed Yeh, I and our colleagues have done during the past ten years. Our efforts showed that CRP causes inflammation in human arteries, and today, our hope is that many heart attacks and strokes can be prevented in the future by translating the information obtained in the JUPITER Trial into the care of patients.”
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