Public health impact of statin prescribing strategies based on JUPITER.
OBJECTIVE
To evaluate the public health impact of statin prescribing strategies based on the Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin Study (JUPITER).


METHODS
We studied 2268 adults aged 35-75 without cardiovascular disease in a population-based study in Switzerland in 2003-2006. We assessed the eligibility for statins according to the Adult Treatment Panel III (ATPIII) guidelines, and by adding "strict" (hs-CRP≥2.0 mg/L and LDL-cholesterol <3.4 mmol/L), and "extended" (hs-CRP≥2.0 mg/L alone) JUPITER-like criteria. We estimated the proportion of CHD deaths potentially prevented over 10 years in the Swiss population.


RESULTS
Fifteen percent were already taking statins, 42% were eligible by ATPIII guidelines, 53% by adding "strict," and 62% by adding "extended" criteria, with a total of 19% newly eligible. The number needed to treat with statins to avoid one CHD death over 10 years was 38 for ATPIII, 84 for "strict" and 92 for "extended" JUPITER-like criteria. ATPIII would prevent 17% of CHD deaths, compared with 20% for ATPIII+"strict" and 23% for ATPIII + "extended" criteria (+6%).


CONCLUSIONS
Implementing JUPITER-like strategies would make statin prescribing for primary prevention more common and less efficient than it is with current guidelines.
Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland. d.nanchen@lumc.nl
David
D
Nanchen
Mark J
MJ
Pletcher
Jacques
J
Cornuz
Pedro-Manuel
PM
Marques-Vidal
Fred
F
Paccaud
Gérard
G
Waeber
Peter
P
Vollenweider
Nicolas
N
Rodondi
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005464:Fluorobenzenes / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000592:standards*; D011634:Public Health; D011743:Pyrimidines / Q000008:administration & dosage*; D018570:Risk Assessment; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000008:administration & dosage*; D016019:Survival Analysis; D013557:Switzerland; D016896:Treatment Outcome
D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium