Another look at the results of the JUPITER trial.
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.
Kappagoda
C Tissa
CT
Amsterdam
Ezra A
EA
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000188:drug therapy*; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D011743:Pyrimidines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012107:Research Design; D012307:Risk Factors; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D002097:C-Reactive Protein; D001241:Aspirin