Following results published back in November on the Astra Zeneca clinical trial of its cholesterol-lowering drug Crestor, sales of the drug have risen sharply. During the trial, named Jupiter, nearly 18,000 patients were either given 20mg of the drug or a placebo. The results were so positive that Jupiter was stopped 6 months early, on the recommendation of an independent monitoring board and the Jupiter steering committee as it was unethical to give the control group the placebo when the group receiving the active ingredient were demonstrating such enormous advantages.
The results, released on the 9th of November, showed that the risk of heart attack was reduced by 54%, strokes by 48% and the need for angioplasty or heart bypass cut by 46% compared to those patients taking a placebo. Over a two year period, patients prescribed the drug experienced a reduced mortality rate of 20%. Clearly, these are impressive and exciting results, though there has been some criticism that had the trial continued, more could have been discovered on how the drug was having such excellent results.
Crestor is part of the class of drug known as 'statins' or HMG CoA reductase inhibitors .The drug works by blocking the cholesterol-producing enzyme HMG-CoA reductase, stopping the production of cholesterol in the liver.This in turn reduces the amount of cholesterol in the blood stream. High cholesterol is dangerous because it increases atheroscelerosis, or the hardening of the arteries. This occurs when fatty deposits named atheroma, made of cholesterol, fat and muscle cells build up in the blood vessels, causing them to narrow. As well as various other cardiovascular problems that can result from this, one of the most serious is that blood clots can form on the areas of atheroma (known as plaques), blocking the blood flow entirely and causing strokes and heart attacks. While an increase in cholesterol in the blood will make this condition far more likely, half of all heart attacks occur in patients with low or normal cholesterol. Therefore, doctors have been forced to search for other ways of predicting risk.
One of the key areas of interest for AstraZeneca, who make
Crestor, was whether the drug could help those with normal or low levels of cholesterol, but a high risk of heart disease. Doctors use elevated level of hs-CRP in the blood hs -CRP is a protein that indicates a predisposition towards developing heart problems - as a way to identify those at risk. Participants in Jupiter had raised levels of CRP and low levels of LDL (low-density lipoprotein what is often refered to as the bad cholesterol). The trial results showed that for those patients, mortality rates could be significantly reduced and levels of hs-CRP lowered.
With cardiovascular disease the second most prevalent cause of ill health and death in the UK, questions are being asked as to whom the wonder drug should be prescribed to. Currently, it is fairly standard practice for patients with a condition putting them in a very high-risk category, for example a medical condition such as a liver disorder, to be prescribed some form of statin. The trial has raised questions as to whether Crestor or similar medicines should also be available to those patients who have a lower-risk element in their lives, predisposing them to heart disease. Such elements might be anything from high cholesterol to a sedentary lifestyle.
Some doctors have expressed fears that drugs such as Crestor will be seen as magic bullets, making people disinclined to put in the hard work that changing high-risk lifestyles requires. Furthermore, the cost to governments national health services and insurance funds of prescribing Crestor to all those who may fall into a relevant risk group may well prohibit the drug becoming more widely prescribed.
That said, the trial has generated a huge amount of excitement in the medical world. The possibility has opened up of averting illness in a far greater section of the population than previously was possible. Crestor seems likely to make a big change in how we view the prevention of heart disease. As awareness grows of the dangers of high cholesterol and the need to maintain a healthy heart, the drug is proving a very useful weapon in the fight against cardiovascular disease.
