The lowdown: There is growing evidence that the CV benefits of statins, which reduce levels of 'bad' low-density lipoprotein (LDL) cholesterol, could in part be related to the anti-inflammatory properties of these drugs (Nature Rev. Drug Discov. 4, 977–987; 2005). For example, previous clinical trials had indicated that hs-CRP levels predict risk of CV events independently of LDL cholesterol levels, and that statin therapy reduces hs-CRP levels. However, there had been no prospective outcome trials to address the question of whether 'apparently healthy' people with levels of LDL cholesterol below current treatment thresholds, but with elevated levels of hs-CRP, might benefit from statin therapy.
With the aim of investigating this question, in the JUPITER study, 17,802 people with hs-CRP >2 mg per litre and LDL <130 mg per decilitre were randomly assigned in a 1:1 ratio to receive 20 mg of rosuvastatin or placebo daily (NEJM 9 Nov 2008; doi:10.1056/NEJMoa0807646). The primary outcome was the occurrence of a first major CV event, defined as non-fatal myocardial infarction, non-fatal stroke, hospitalization for unstable angina, an arterial revascularization procedure, or confirmed death from CV causes. The trial was stopped early, after a median follow-up of 1.9 years, when the data and safety monitoring board noted a significant reduction in the primary end point among participants assigned to receive rosuvastatin; there were 142 primary events in the rosuvastatin group compared with 251 in the placebo group (hazard ratio for rosuvastatin 0.56, p <0.00001).
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