Abstract
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.
MeSH terms
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Angina, Unstable / etiology
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Angina, Unstable / prevention & control
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Biomarkers / blood
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C-Reactive Protein / metabolism*
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Cardiovascular Diseases / blood
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Cardiovascular Diseases / etiology
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Cardiovascular Diseases / mortality
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Cardiovascular Diseases / prevention & control*
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Female
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Fluorobenzenes / adverse effects
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Fluorobenzenes / therapeutic use*
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Hospitalization
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Humans
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Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
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Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
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Inflammation / blood
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Inflammation / complications
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Inflammation / drug therapy*
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Inflammation / mortality
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Inflammation Mediators / blood*
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Male
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Middle Aged
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Multicenter Studies as Topic
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Myocardial Infarction / etiology
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Myocardial Infarction / prevention & control
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Patient Selection
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Practice Guidelines as Topic
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Predictive Value of Tests
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Primary Prevention*
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Pyrimidines / adverse effects
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Pyrimidines / therapeutic use*
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Randomized Controlled Trials as Topic
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Risk Assessment
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Risk Factors
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Rosuvastatin Calcium
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Stroke / etiology
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Stroke / prevention & control
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Sulfonamides / adverse effects
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Sulfonamides / therapeutic use*
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Treatment Outcome
Substances
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Biomarkers
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Fluorobenzenes
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Hydroxymethylglutaryl-CoA Reductase Inhibitors
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Inflammation Mediators
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Pyrimidines
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Sulfonamides
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Rosuvastatin Calcium
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C-Reactive Protein