Well, for one, I like how it goes against a lot of the hype of the trial by pointing out a lot of flaws with how the results are being presented and things that could be improved. Like, for one, the NNT for events being higher than reported for the actual length of the trial (1.9 years) versus predicted lengths in the trial by the authors (2 years and 4 years).
He makes good points about how the trial didn't compare treatment vs. placebo in patients with low-risk CRP levels and no hyperlipidemia, about how hs-CRP isn't specific for just atherosclerosis (can be affected by cancer, autoimmune disease, and heck, just being female), about how we don't know the long-term effects of intensive statin therapy and lowering LDL to the amounts it was lowered to in the trial.
One thing he failed to mention when he talks about how Crestor is more expensive than the generic statins are, at least in the real world, cash prices that I've seen of Crestor vs Lipitor is that Crestor is slightly less expensive per day than Lipitor...right now. However, Lipitor is slated to lose its patent in March 2010, and so, I feel if there is a "mad rush" to convert people to Crestor from Lipitor, the life of that would only be as long as the remaining life of the patent. Plus, the study was funded by AstraZeneca, and Dr. Ridker is affiliated with them and has the patent to the hs-CRP assay...
Did you notice that 15.6% of those in the study were smokers and 41.4% had metabolic syndrome? Both are causes for increase in CRP, and those populations have an increased risk of CVD anyway. Unfortunately the trial doesn't specify to which groups those subjects belonged or if they were split evenly between groups (probably not because of the randomization technique). These were all supposed to have been "apprently healthy" subjects."
Like many others, I don't think this trial warrants a change in guidelines or practice. Further research? Sure. But, as far as statins lowering CRP, that's been proven before with PRINCE, PROVE IT/TIMI 22, etc.
