Key result
Rosuvastatin 20 mg daily reduced nonfatal myocardial infarction by 55%, nonfatal stroke by 48%, and all-cause mortality by 20% compared to placebo in healthy individuals with elevated CRP.
Why the study?
Does rosuvastatin 20 mg daily reduce the composite of nonfatal myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or cardiovascular death in apparently healthy middle-aged men and women with elevated CRP and normal LDL?
RCT (n=17,802)
randomized
Does rosuvastatin 20 mg daily reduce the composite of nonfatal myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or cardiovascular death in apparently healthy middle-aged men and women with elevated CRP and normal LDL?
In apparently healthy individuals with elevated CRP but normal LDL, rosuvastatin significantly reduces major adverse cardiovascular events and all-cause mortality.
May support primary prevention in elevated CRP; leaves open dedicated trial confirmation before practice change.
CRP levels are strong, independent predictors of cardiovascular risk and can enhance risk stratification. Jupiter enrolled 17 802 apparently healthy middle-aged men and women with CRP levels over 2.0 mg/l, and LDL less than 130 mg/dl. They were randomized to receive rosuvastatin 20 mg daily or placebo, and followed for a primary endpoint of nonfatal myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or cardiovascular death for 1.9 years. Rosuvastatin lowered CRP (37%), LDL (50%), nonfatal myocardial infarction (55%), nonfatal stroke (48%), hospitalization and revascularization (47%), all-cause mortality (20%), and benefited women and minority subgroups. Rosuvastatin was tolerated relatively well, with a small rise in physician-reported diabetes. Jupiter data suggest that patients with high levels of CRP should receive statins. Approximately 4.3% of the population satisfies Jupiter inclusion criteria. A review of the assessment of cardiovascular risk is under way at the National Institutes of Health to guide practitioners.
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Richard Kones (2009) conducted an RCT in Primary prevention of cardiovascular disease (n=17,802). rosuvastatin vs. placebo was evaluated on nonfatal myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or cardiovascular death. Rosuvastatin 20 mg daily reduced nonfatal myocardial infarction by 55%, nonfatal stroke by 48%, and all-cause mortality by 20% compared to placebo in healthy individuals with elevated CRP.