title: Are cardiovascular benefits in statin lipid effects dependent on baseline lipid levels?
abstract: Statins reduce coronary heart disease (CHD) morbidity and mortality over a wide range of patients. The Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) in subjects with elevated C-reactive protein, without vascular disease and below average low-density lipoprotein cholesterol (LDL-C) showed a 50% reduction in LDL-C with 20 mg/d of rosuvastatin and a reduction in cardiovascular events (hazard ratio 0.56 [95% CI, 0.46-0.69]; P < 0.00001), and a reduction in total mortality (20%; P < 0.02). Recent commentary has criticized perceived JUPITER design flaws and inappropriate influence. However, the Canadian 2009 guidelines cite JUPITER as class I evidence for statin benefit. Although the Cholesterol Treatment Trialists' (CTT) Collaborators showed that, regardless of pre-treatment levels, statins can significantly reduce CHD, major vascular events, and overall mortality, a recent primary prevention meta-analysis showed no decrease in all-cause mortality. Preconceived notions on statin benefit or harm do not enhance patient care and clinicians should individualize long-term statin therapy.
authors.affiliation: Division of Cardiology, Emory University, 5355 Hunter Rd., Atlanta, GA 30349, USA. kferdinand@abcardio.org
authors.forename: Keith C
authors.initials: KC
authors.lastname: Ferdinand
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D002097:C-Reactive Protein / Q000378:metabolism; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D050356:Lipid Metabolism / Q000187:drug effects*; D008134:Long-Term Care; D054539:Medication Therapy Management; D015201:Meta-Analysis as Topic; D009026:Mortality; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013995:Time
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein