The JUPITER study, recently published at the American College of Cardiology (AHA) New Orleans meeting, showed new statins in patients with low levels of low-density lipoprotein cholesterol (LDL-C) but elevated C-reactive protein (CRP). Rosuvastatin may play a new role. It can reduce the risk of heart attack, stroke, unstable angina/vascular revascularization, and cardiovascular death in this disease group by 44%. According to current treatment guidelines, this population is not suitable for statin therapy. However, some other experts who participated in the meeting thought it would be too early to propose changes to the current clinical guidelines based on the results of the study.
There is evidence that half of all heart attacks and strokes occur on superficially healthy people with average or low LDL-cholesterol levels. High-sensitivity CRP (hsCRP) is an inflammatory biomarker that independently predicts future cardiovascular (CV) events, so doctors often use it to detect patients with elevated CV risk. Statins have a role other than lipid lowering, and reducing inflammation is one of these so-called pleiotropic effects. A study in 2001 found that the incidence of vascular events in patients with low LDL-C but high hsCRP was as high as in patients with hyperlipidemia, so treatment with statins may significantly reduce these events.
JUPITER was designed to further test this hypothesis and is a clinical trial of statins for this patient population. A total of 17,802 superficially healthy men (over 50 years old) and females (over 60 years old) from 216 countries participated in LDL-C levels below 130 mg/dl (ie 3.4 mmol/L, lower than the current one) Level of prevention threshold) and hsCRP level of 2.0 mg/L or higher. Patients were randomized to receive 20 mg/day rosuvastatin or placebo in a 1:1 ratio. These participants did not previously have cardiovascular disease or diabetes. At the end of the study, patients' LDL-C levels were reduced by 50% to an average of 55 mg/dl (lower than previously reported statin studies) and hsCRP levels were reduced by 37%. The ratios of the sulvavastatin group and the placebo group reaching the primary evaluation end point (myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina or cardiovascular death) were 0.77 and 1.36/100 persons respectively. During the year of the visit, the hazard ratio for rosuvastatin was 0.56. 142/8901 patients in the rosuvastatin group experienced a primary endpoint, compared with 251/8901 in the placebo group, with statistically significant differences between the two groups. The main researcher, P Ridker of Harvard Medical School, believes that the use of rosuvastatin treatment has a good cost-effectiveness in primary prevention. He mentioned that the hospitalization and revascularization rate seen during the two-year follow-up period decreased by 47%, suggesting that the screening and treatment strategies of the JUPITER study may be cost-effective. In addition, 6375 patients who participated in the study had no other risk factors except for elevated hsCRP, and their first event rate decreased by 37%. This data suggests that inflammation may be associated with elevated coronary risk.
In terms of safety, in general, rosuvastatin is safe. There was no significant difference in the incidence of muscle weakness, myopathy, and rhabdomyolysis between the two study branches. More notably, there was a significant reduction in the number of cases of cancer deaths during the study period, 35 in the rosuvastatin group, and 58 in the placebo group. There was no significant difference in the incidence of cancer in the two branches (298 pairs). 314 cases). However, doctors reported that the rosuvastatin-treated group was more likely to have diabetes than the placebo group, with 245 versus 196 patients, similar to the trends reported in previous clinical trials of all statins.
The mechanism by which rosuvastatin reduces CRP levels and event rates in this population remains unclear. In fact, all statins have the effect of reducing inflammation and lowering LDL-C, except that rosuvastatin is strong in both respects.
There is evidence that half of all heart attacks and strokes occur on superficially healthy people with average or low LDL-cholesterol levels. High-sensitivity CRP (hsCRP) is an inflammatory biomarker that independently predicts future cardiovascular (CV) events, so doctors often use it to detect patients with elevated CV risk. Statins have a role other than lipid lowering, and reducing inflammation is one of these so-called pleiotropic effects. A study in 2001 found that the incidence of vascular events in patients with low LDL-C but high hsCRP was as high as in patients with hyperlipidemia, so treatment with statins may significantly reduce these events.
JUPITER was designed to further test this hypothesis and is a clinical trial of statins for this patient population. A total of 17,802 superficially healthy men (over 50 years old) and females (over 60 years old) from 216 countries participated in LDL-C levels below 130 mg/dl (ie 3.4 mmol/L, lower than the current one) Level of prevention threshold) and hsCRP level of 2.0 mg/L or higher. Patients were randomized to receive 20 mg/day rosuvastatin or placebo in a 1:1 ratio. These participants did not previously have cardiovascular disease or diabetes. At the end of the study, patients' LDL-C levels were reduced by 50% to an average of 55 mg/dl (lower than previously reported statin studies) and hsCRP levels were reduced by 37%. The ratios of the sulvavastatin group and the placebo group reaching the primary evaluation end point (myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina or cardiovascular death) were 0.77 and 1.36/100 persons respectively. During the year of the visit, the hazard ratio for rosuvastatin was 0.56. 142/8901 patients in the rosuvastatin group experienced a primary endpoint, compared with 251/8901 in the placebo group, with statistically significant differences between the two groups. The main researcher, P Ridker of Harvard Medical School, believes that the use of rosuvastatin treatment has a good cost-effectiveness in primary prevention. He mentioned that the hospitalization and revascularization rate seen during the two-year follow-up period decreased by 47%, suggesting that the screening and treatment strategies of the JUPITER study may be cost-effective. In addition, 6375 patients who participated in the study had no other risk factors except for elevated hsCRP, and their first event rate decreased by 37%. This data suggests that inflammation may be associated with elevated coronary risk.
In terms of safety, in general, rosuvastatin is safe. There was no significant difference in the incidence of muscle weakness, myopathy, and rhabdomyolysis between the two study branches. More notably, there was a significant reduction in the number of cases of cancer deaths during the study period, 35 in the rosuvastatin group, and 58 in the placebo group. There was no significant difference in the incidence of cancer in the two branches (298 pairs). 314 cases). However, doctors reported that the rosuvastatin-treated group was more likely to have diabetes than the placebo group, with 245 versus 196 patients, similar to the trends reported in previous clinical trials of all statins.
The mechanism by which rosuvastatin reduces CRP levels and event rates in this population remains unclear. In fact, all statins have the effect of reducing inflammation and lowering LDL-C, except that rosuvastatin is strong in both respects.
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