The Jupiter study, CRP screening, and aggressive statin therapy-implications for the primary prevention of cardiovascular disease

Ther Adv Cardiovasc Dis. 2009 Aug;3(4):309-15. doi: 10.1177/1753944709337056. Epub 2009 May 21.

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.

Publication types

  • Review

MeSH terms

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

Substances

  • Biomarkers
  • Fluorobenzenes
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Inflammation Mediators
  • Pyrimidines
  • Sulfonamides
  • Rosuvastatin Calcium
  • C-Reactive Protein