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Clinical Implications of JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) in a U.S. Population Insights From the ARIC (Atherosclerosis Risk in Communities) Study Yang EY et al. J Am Coll Cardiol, 2009; 54:2388-2395, doi:10.1016/j.jacc.2009.10.006 Conclusions: ARIC participants with elevated hs-CRP and low LDL-C had a CVD event rate of 1.57% per year over 6.9 years, similar to the CVD event rate noted in the JUPITER study placebo group (1.36% per year over 1.9 years). The association of hs-CRP ≥2.0 mg/l with increased CVD risk and mortality regardless of LDL-C provides us a simple method of using age and hs-CRP level for identifying higher risk individuals. (Atherosclerosis Risk in Communities study; NCT00005131)

"New research shows a long-term benefit in screening people for CRP, a marker for inflammation, even if they have normal levels of bad cholesterol, because of increased long-term risk for heart attack, stroke and death. These findings, which will be published online today in the Journal of the American College of Cardiology (JACC), demonstrate that a very simple screening, age plus CRP, can identify individuals who may benefit from statin therapy. "This study builds on results from the landmark JUPITER trial, which showed that statins can prevent heart disease in people with normal LDL-c, or bad cholesterol, and an increased level of CRP," said Dr. Christie Ballantyne, director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart & Vascular Center and last author on the study. "We have demonstrated that the cardiovascular disease event rates persist over time, validating that the risks identified in the JUPITER trial persist for nearly seven year"

"November 25, 2009 | Michael O'Riordan Orlando, FL - Treating healthy women with low LDL cholesterol but elevated high-sensitivity C-reactive protein (hsCRP) levels with rosuvastatin (Crestor, AstraZeneca) cuts their risk of cardiovascular events in half, according to a new analysis of Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER). The reduction in risk is consistent with the reduction observed in the overall trial, and with the 42% benefit observed in men.

"Largest-ever meta-analysis finds CRP is unlikely to be causal for CVD December 21, 2009 | Lisa Nainggolan Cambridge, UK - In the largest and most comprehensive meta-analysis to date looking at C-reactive-protein (CRP) levels and risk of coronary heart disease (CHD) and stroke, British researchers conclude that CRP is unlikely to be a causal factor for cardiovascular disease [1]. Although CRP concentration was linearly associated with CHD, stroke, and vascular mortality, as well as nonvascular mortality, statistical adjustment for conventional cardiovascular risk factors "resulted in considerable weakening of associations," note the scientists of the Cambridge-based Emerging Risk Factors Collaboration (ERFC), who report their findings online December 21, 2009 in the Lancet. In an editorial accompanying the paper [2], Drs S Matthijs Boekholdt and John JP Kastelein (Academic Medical Center, Amsterdam, the Netherlands) say the UK authors "are to be commended for this impressive data set." Although the findings "add weight to the evidence of noncausality" for a role of CRP in the development of cardiovascular disease, "the debate can be resolved only by randomized trials with agents that specifically target CRP, and such compounds are currently under development," say the Dutch doctors. Commenting on the new meta-analysis for heartwire, Dr Paul Ridker (Brigham and Women's Hospital, Boston, MA), a long-time advocate of CRP and the lead investigator of the JUPITER trial, said: "Whether or not CRP is 'causal' for heart disease is neither the crucial issue at hand nor relevant for public health. What is crucial is getting international agreement that CRP identifies higher-risk individuals who would not otherwise qualify for a life-saving therapy, and then showing that such individuals clearly benefit from treatment. The new meta-analysis demonstrates the former, and JUPITER demonstrates the latter." "

Expanding the orbit of primary prevention--moving beyond JUPITER. Hlatky MA. N Engl J Med. 2008 Nov 20;359(21):2280-2. Epub 2008 Nov 9. PMID: 18997195

"March 29, 2009 | Michael O'Riordan Orlando, FL - Reducing LDL cholesterol and high-sensitivity C-reactive protein (hs-CRP) in primary-prevention patients treated with rosuvastatin (Crestor, AstraZeneca) results in better event-free survival than when neither of these targets are achieved or when LDL cholesterol alone is reduced, a new analysis shows [1]. Presenting the results of the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study during an afternoon press conference at the American College of Cardiology 2009 Scientific Sessions, investigators say that initial interventions for low-risk primary-prevention patients remains lifestyle and dietary modifications, but for those choosing drug therapy, "reductions in both LDL cholesterol and hs-CRP are indicators of the success of treatment with statin therapy.""

What is C-reactive protein (CRP)? It is a blood-borne protein that originates in the liver and serves as an index of the body's inflammatory state. It is triggered by yet another inflammatory signal molecule, interleukin-6. What triggers this cascade of inflammatory markers? Any inflammatory stimulus, such as being overweight, lack of exercise, vitamin D deficiency, viral illness no matter how trivial, any inflammatory disease like arthritis, small LDL, high triglycerides, poor diet rich in processed foods, resistance to insulin, any injury, incipient diabetes, hidden cancer, lack of education (no kidding), etc.

Conclusions In this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events. \n\nRosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.\nRidker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ; JUPITER Study Group.\nN Engl J Med. 2008 Nov 20;359(21):2195-207. Epub 2008 Nov 9.\nPMID: 18997196

Last week, Harvard researchers reported how healthy 50-year-old men and 60-year-old women could benefit from taking a statin even if they didn't have high cholesterol. The people they studied had high levels of C-reactive protein, or CRP, which is a marker for inflammation. The study showed that risk for major heart problems was cut by about 50 percent among the statin users.\n\nBut like many industry-sponsored drug studies, the results focused on something called "relative risk," which compares differences between study groups. Relative risk has the effect of exaggerating a drug's benefits. What does a 50 percent reduction in heart risk mean? It means that just one out of 120 statin users was helped by the drug.

Judging by recent headlines, you might think so. Last week heart researchers reported that millions of healthy people could benefit from taking statins even if they don't have high cholesterol.\n\nAlthough many doctors hailed the study as a major breakthrough, a closer look at the research suggests that statins (like Crestor, from AstraZeneca, and Lipitor, from Pfizer) are far from magic pills. While they clearly save lives in people with a previous heart attack or other serious heart problems, for an otherwise healthy person the potential benefit remains small.

CHART: Statins Reduce Risks: A study of 18,000 people with high levels of C-reactive protein, or CRP, found that the risk of a heart attack or stroke was cut in half among those who took a statin. The study was stopped after two years, but some participants were tracked for up to five years. (Sources: Dr. Paul M. Ridker; New England Journal of Medicine) (pg.A21) A large new study suggests that millions more people could benefit from taking the cholesterol-lowering drugs known as statins, even if they have low cholesterol, because the drugs can significantly lower their risk of heart attacks, strokes and death. The study, involving nearly 18,000 people worldwide, tested statin treatment in men 50 and older and in women 60 and older who did not have high cholesterol or histories of heart disease. What they did have was high levels of a protein called high-sensitivity C-reactive protein, or CRP, which indicates inflammation in the body.