The story highlights one patient anecdote integrating a rather controversial laboratory test, high sensitivity c-reactive protein. While it provides some of the important background, it fails to place the test in context by not providing any information suggesting the test may not be as valuable as suggested. Overall, the result is a rather one-sided story. The reader is not provided with any real information concerning the debate, any detailed information about the JUPITER study other than the results in relative terms or more recent studies that would appear to be in conflict with the the positions stated by the interviewees. Harms, including the side effects associated with the statins and their cost are not provided.
Identifying risk factors for cardiovascular disease is very much a moving target with additional information either confirming or refuting the value of routine tests. C-reactive protein and its more recent offspring, hs-CRP, has been touted by some as a definitive test as a cardiovascular risk factor. What has not been shown is whether or not treating people with drugs and lifestyle changes simply on the basis of the test is of value.
Any story about a screening test should not only include the cost of the test (which this story did not), but more importantly, the costs of preventive care. In this case, the use of a statin drug simply based on a rather controversial laboratory test
The story quotes the inventor of the test and an advocate for its use using the results of the Jupiter Study as a reference. The reader is provided with virtually no information about the study or its results other than the comments of the senior researcher. In reality, the Jupiter study did not have a control group (those with low hs-CRP levels). A more recent and larger study demonstrated that treatment with a statin reduced events even in people with low baseline CRP levels. (see Heart Protection Study Collaborative G. C-reactive protein concentration and the vascular benefits of statin therapy: an analysis of 20,536 patients in the Heart Protection Study. Lancet. 2011;377:469–476.)
This is another example of a story about a screening test that didn’t provide any information about the potential harms associated. While there are those who believe that the hs-CRP alone warrants drug treatment, this is not a universally held view. While the statins are relatively safe, they are not without potential side effects and are relatively expensive for the twenty plus years of potentially unnecessary treatment
The story provides very little evidence to support the use of hs-CRP other than the comments of an advocate and the inventor of the test. The story provides, “The 2008 study showed that in patients with low levels of LDL—the bad cholesterol—but high hs-CRP levels, the statin Crestor reduced the risk of heart-related death, heart attacks and other serious cardiac problems by 44% compared with those given placebos.” The relative risk doesn’t tell us much and as we noted previously, the study did not have a control group. The more recent Heart Protection Study, included a control group and demonstrated reduced cardiovascular events in people treated with a different statin regardless of their c-reactive protein levels.
We think that statements such as, “And one major study suggests that even people with minimal risk factors in their late 50s and early 60s should have the test” and “But genetic factors can also contribute to elevated CRP in people without traditional risk factors” would leave many readers with the impression that just about everyone needs to have the test performed.
For the record, the US Preventive Services Task Force states: “The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors (including high-sensitivity C-reactive protein – hs-CRP) …to screen asymptomatic men and women with no history of CHD to prevent CHD events.”
Although the story did provide some information about the controversy (“While some experts don’t think the hs-CRP test adds much to current cardiovascular risk-prediction strategies,…”) the majority of the comments are made by the principal investigator/inventor and an apparent advocate of the test. We would have liked to have seen more balance in the story. Fewer than 20 words to wave off skepticism, the other 838 words all devoted to those who promote the test. Why, based on what is provided in the story would any expert not believe in the test? The story doesn’t give any space for that perspective.
Because of the imbalance in its framing, the story doesn’t even discuss the option of not having the test – which can be a rational choice. The framing – “simple blood test…easily done at the same time as a cholesterol screening, and covered by most insurance” – is promotional. Why don’t some experts think this test adds much? What is the evidence for that perspective? That alternative viewpoint is clearly downplayed.
The story makes it clear that the test is available and most insurers will pay for it.
The story makes it clear that the c-reactive protein has been around for many years and provides a partial listing of the important studies performed.
No evidence of a press release as a source.