Statin therapy could benefit patients with elevated levels of ultra-sensitive C-reactive protein (US-CRP), even those with normal cholesterol levels, according to the results of the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER trial).
More than 15,000 participants (women older than age 60 and men older than age 50) without cardiovascular disease enrolled in the study, which included 1,315 sites in 26 countries. All patients had normal cholesterol levels (low-density lipoprotein [LDL] cholesterol<130 mg/dL) and elevated levels of US-CRP (2.0 mg/L or higher). C-reactive protein (a marker of inflammation) is an independent risk factor for cardiovascular disease.
Participants were divided into two groups: those who received rosuvastatin (Crestor) 20 mg daily and those who received a placebo. The trial was intended to run for five years, but ended after 1.9 years because of the overwhelming positive results among the patients who received rosuvastatin compared with those who received placebo. The benefits associated with rosuvastatin were a reduction of cardiovascular events, including a 54% reduction in heart attacks and a 48% reduction in stroke; a 46% reduction in the need for angioplasty or coronary artery bypass surgery; and a 20% reduction in all cause mortality compared with participants that received placebo. Levels of US-CRP were reduced by 37%, and LDL cholesterol levels were reduced by 50%. These results demonstrated for the first time that statin therapy was highly effective in women as well as minority groups, which are groups typically excluded in clinical trials.
Ridker PM, Danielson E, Fonesca FA, et al; JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. New Engl J Med. 2008;359:21895-2207.