The JUPITER trial investigated whether rosuvastatin 20 mg, compared with placebo, would reduce the rate of a first major cardiovascular event among apparently healthy men and women with LDL-C <130 mg/dL (<3.36 mmol/L) who are still considered at increased vascular risk based on an enhanced inflammatory response (ie, with high-sensitivity C-reactive protein [hsCRP] levels >2 mg/L). It included large numbers of women, a patient group for whom little data on primary prevention with statin therapy exists.

“Among apparently healthy men and women with elevated hsCRP but low LDL-C, rosuvastatin reduced the incidence of myocardial infarction, stroke, and cardiovascular death by 47%,”explained Dr Paul Ridker, chief investigator of JUPITER and Eugene Braunwald Professor of Medicine at Harvard University. “Despite evaluating a population with lipid levels widely considered to be ‘optimal’ in almost all current prevention algorithms, the relative benefit observed in JUPITER was greater than in almost all prior statin trials. In low LDL/high hsCRP individuals who do not currently qualify for statin therapy, rosuvastatin significantly reduced all-cause mortality by 20%,” he continued. Other significant study findings include:

• Rosuvastatin’s efficacy was consistent in all subgroups evaluated, regardless of age, sex, ethnicity, or other baseline clinical characteristics
• The 47% reduction in the rates of hospitalization and revascularization within a 2-year period suggests a cost-effective screening and treatment strategy, benefiting both patients and heath service providers
• For the primary endpoint, the number-needed-to-treat in JUPITER was 25, a value smaller than that associated with primary prevention hyperlipidemia treatment

Exercise, diet, and smoking cessation remain the first interventions for patients with elevated LDL-C or hsCRP. However, the application of the simple screening and treatment strategy tested in the JUPITER trial over a 5-year period could reduce myocardial infarction, strokes, and revascularization procedures by 50%. Dr Ridker emphasized that, “simplified guidelines advocating combined lifestyle and pharmacologic therapy in the groups shown to have a net benefit bring much promise in improving patient care and public health.” Gathering data from local communities is encouraged to facilitate the development of relevant local guidelines.