doi: 10.1161/CIRCOUTCOMES.109.868299
Cardiovascular Perspectives |
The JUPITER Trial
Results, Controversies, and Implications for Prevention
From the Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiovascular Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.
Correspondence to Paul Ridker, MD, MPH, Director, Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, 900 Commonwealth Avenue East, Boston, MA 02215. E-mail pridker@partners.org
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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Statin therapy is effective at reducing cardiovascular event rates among those with prior myocardial infraction, stroke, diabetes, or overt hyperlipidemia, and current guidelines strongly recommend lipid-lowering therapy among these patient groups as an adjunct to aggressive lifestyle interventions. However, of the nearly 1.7 million heart attacks and strokes that occur annually in the United States, more than half occur among apparently healthy men and women with average or low levels of cholesterol. Thus, novel screening and treatment strategies for cardiovascular prevention are needed that can detect high vascular risk in the absence of hyperlipidemia, that are inexpensive and simple to implement in the primary care setting, and that can provide comparable or superior effectiveness compared to currently accepted approaches.
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Justification for the Use of Statin in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER): Rationale and Prespecified Analyses |
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In a collaborative effort involving 1315 physicians in 26 countries, the JUPITER investigators1 sought to determine whether statin therapy might be effective at preventing first-ever cardiovascular events among men and women at risk for vascular disease because of elevated levels of the inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) but who are not candidates for statin therapy under accepted guidelines because of low-density lipoprotein cholesterol (LDLC) levels less than 130 mg/dL, the current treatment target for primary prevention.
JUPITER was a formal hypothesis testing trial based on prior observations that (1) inflammation plays a crucial role in atherogenesis2; (2) that the inflammatory biomarker hsCRP independently predicts vascular events and improves global classification of risk regardless of LDLC level3–6; (3) that statin therapy reduces hsCRP in a manner largely independent of
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