1.
Another look at the results of the JUPITER trial.
Kappagoda, CT, Amsterdam, EA
The American journal of cardiology. 2009;(11):1603-5
Abstract
Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) was a placebo-controlled trial undertaken on "apparently healthy" subjects selected primarily on the basis of high-sensitivity C-reactive protein concentrations >or=2.0 mg/L. JUPITER showed that rosuvastatin reduced the incidence of cardiac events compared to a control group. The study population (median age 66 years) included men and women with the metabolic syndrome (about 41%), median blood pressures in the prehypertensive range, current smoking (about 15%), median body mass indexes higher than normal, and Framingham 10-year risk >10% (about 50%). The presence of these risk factors indicates that a significant proportion of subjects were not "healthy" and warranted aggressive management under current guidelines, without the measurement of high-sensitivity C-reactive protein. Furthermore, <17% of the trial participants were taking guidelines-recommended aspirin, and 25% had systolic blood pressures >145 mm Hg and would have merited treatment for hypertension. It is likely that many of the participants did not receive care consistent with current standards. Thus, the benefit of statin therapy would have been more difficult to demonstrate if standard therapeutic recommendations had been followed. In conclusion, these considerations cast doubt on the contention that statin therapy should be initiated in apparently healthy individuals on the basis of elevated high-sensitivity C-reactive protein levels.
2.
Do we need a statin-nicotinic acid-aspirin mini-polypill to treat combined hyperlipidaemia?
Athyros, VG, Tziomalos, K, Mikhailidis, DP, Pagourelias, ED, Kakafika, AI, Skaperdas, A, Hatzitolios, A, Karagiannis, A
Expert opinion on pharmacotherapy. 2007;(14):2267-77
Abstract
This review considers the treatment for combined hyperlipidaemia (CH) with a combination formulation of three drugs: a statin, nicotinic acid (NA) and aspirin--a mini-polypill. CH is a highly atherogenic dyslipidaemia manifested either as familial combined hyperlipidaemia or dyslipidaemia related to the metabolic syndrome or Type 2 diabetes mellitus. These types of dyslipidaemia are highly prevalent in the general population. Statin plus extended-release NA is a promising treatment option for the normalisation of these atherogenic lipid alterations, regression of atherosclerosis, as well as for primary or secondary prevention of cardiovascular disease (CVD) events. The addition of aspirin might prove a useful adjunct that might reduce the cutaneous side effects of NA while also acting as an antiplatelet agent in high-CVD-risk patients. However, the effective dose of aspirin may need to be at least 160 mg/day. This triple combination might improve patient compliance when compared with the three drugs administered separately.
3.
Plasma sex steroid hormones and risk of developing type 2 diabetes in women: a prospective study.
Ding, EL, Song, Y, Manson, JE, Rifai, N, Buring, JE, Liu, S
Diabetologia. 2007;(10):2076-84
Abstract
AIMS/HYPOTHESIS Prospective data directly investigating the role of endogenous sex hormones in diabetes risk have been scant, particularly in women. We aimed to examine comprehensively plasma sex hormones in connection with risk of developing type 2 diabetes in postmenopausal women. METHODS We conducted a prospective, nested case-control study of plasma oestradiol, testosterone and dehydroepiandrosterone sulfate and risk of type 2 diabetes in a cohort of women health professionals with a mean age of 60.3 and 12.2 years since menopause. Among women not using hormone therapy and free of baseline cardiovascular disease, cancer and diabetes, 359 incident cases of type 2 diabetes were matched with 359 controls during an average follow-up of 10 years. RESULTS Oestradiol and testosterone were each strongly and positively associated with risk of type 2 diabetes. After adjustment for BMI, family history, lifestyle and reproductive variables, the multivariable relative risks (95% CI) comparing the highest vs lowest quintile were 12.6 (2.83-56.3) for total oestradiol (p = 0.002 for trend), 13.1 (4.18-40.8) for free oestradiol (p < 0.001 for trend), 4.15 (1.21-14.2) for total testosterone (p = 0.019 for trend) and 14.8 (4.44-49.2) for free testosterone (p < 0.001 for trend). These associations remained robust after adjusting and accounting for other metabolic syndrome components and baseline HbA(1c) levels. CONCLUSIONS/INTERPRETATION In postmenopausal women, higher plasma levels of oestradiol and testosterone were strongly and prospectively related to increased risk of developing type 2 diabetes. These prospective data indicate that endogenous levels of sex hormones may play important roles in the pathogenesis of type 2 diabetes. ClinicalTrials.gov ID no.: NCT00000479.