title: Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study.
abstract: BACKGROUND
  The JUPITER trial showed that some patients with LDL-cholesterol concentrations less than 3·37 mmol/L (<130 mg/dL) and high-sensitivity C-reactive protein (hsCRP) concentrations of 2 mg/L or more benefit from treatment with rosuvastatin, although absolute rates of cardiovascular events were low. In a population eligible for JUPITER, we established whether coronary artery calcium (CAC) might further stratify risk; additionally we compared hsCRP with CAC for risk prediction across the range of low and high hsCRP values.
  
  
  METHODS
  950 participants from the Multi-Ethnic Study of Atheroslcerosis (MESA) met all criteria for JUPITER entry. We compared coronary heart disease and cardiovascular disease event rates and multivariable-adjusted hazard ratios after stratifying by burden of CAC (scores of 0, 1-100, or >100). We calculated 5-year number needed to treat (NNT) by applying the benefit recorded in JUPITER to the event rates within each CAC strata.
  
  
  RESULTS
  Median follow-up was 5·8 years (IQR 5·7-5·9). 444 (47%) patients in the MESA JUPITER population had CAC scores of 0 and, in this group, rates of coronary heart disease events were 0·8 per 1000 person-years. 74% of all coronary events were in the 239 (25%) of participants with CAC scores of more than 100 (20·2 per 1000 person-years). For coronary heart disease, the predicted 5-year NNT was 549 for CAC score 0, 94 for scores 1-100, and 24 for scores greater than 100. For cardiovascular disease, the NNT was 124, 54, and 19. In the total study population, presence of CAC was associated with a hazard ratio of 4·29 (95% CI 1·99-9·25) for coronary heart disease, and of 2·57 (1·48-4·48) for cardiovascular disease. hsCRP was not associated with either disease after multivariable adjustment.
  
  
  CONCLUSIONS
  CAC seems to further stratify risk in patients eligible for JUPITER, and could be used to target subgroups of patients who are expected to derive the most, and the least, absolute benefit from statin treatment. Focusing of treatment on the subset of individuals with measurable atherosclerosis could allow for more appropriate allocation of resources.
  
  
  BACKGROUND
  National Institutes of Health-National Heart, Lung, and Blood Institute.
authors.affiliation: Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD 21287, USA. mblaha1@jhmi.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Andrew P
authors.initials: AP
authors.lastname: DeFilippis
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Rivera
authors.forename: Arthur
authors.initials: A
authors.lastname: Agatston
authors.forename: Daniel H
authors.initials: DH
authors.lastname: O'Leary
authors.forename: Joao
authors.initials: J
authors.lastname: Lima
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D002118:Calcium / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000378:metabolism* / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000378:metabolism* / Q000517:prevention & control; D003327:Coronary Disease / Q000175:diagnosis / Q000378:metabolism / Q000517:prevention & control; D003331:Coronary Vessels / Q000378:metabolism*; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000627:therapeutic use; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D008078:Cholesterol, LDL; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D002097:C-Reactive Protein; D002118:Calcium