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The Jupiter study, CRP screening, and aggressive statin therapy-implications for the primary prevention of cardiovascular diseaseCardiometabolic Research Institute, 8181 Fannin St, 314, Houston, TX 77054 USA, drrkones{at}comcast.net CRP levels are strong, independent predictors of cardiovascular risk and can enhance risk stratification. Jupiter enrolled 17 802 apparently healthy middle-aged men and women with CRP levels over 2.0 mg/l, and LDL less than 130 mg/dl. They were randomized to receive rosuvastatin 20 mg daily or placebo, and followed for a primary endpoint of nonfatal myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or cardiovascular death for 1.9 years. Rosuvastatin lowered CRP (37%), LDL (50%), nonfatal myocardial infarction (55%), nonfatal stroke (48%), hospitalization and revascularization (47%), all-cause mortality (20%), and benefited women and minority subgroups. Rosuvastatin was tolerated relatively well, with a small rise in physician-reported diabetes. Jupiter data suggest that patients with high levels of CRP should receive statins. Approximately 4.3% of the population satisfies Jupiter inclusion criteria. A review of the assessment of cardiovascular risk is under way at the National Institutes of Health to guide practitioners.
Key Words: Jupiter trial • cholesterol • C-reactive protein • coronary artery disease • primary prevention • statin drugs • cardiovascular risk • heart risk factors • lipoprotein (a) • low density lipoprotein • high density lipoprotein • preventive cardiology • metabolic syndrome • cardiovascular screening • rosuvastatin • statin drugs • HMG CoA reductase inhibitors
This version was published on August
1, 2009 Therapeutic Advances in Cardiovascular Disease, Vol. 3, No. 4,
309-315 (2009) |
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