High-sensitivity C-reactive protein, statin therapy, and risks of atrial fibrillation: an exploratory analysis of the JUPITER trial
Key result
Rosuvastatin 20 mg daily reduces incident atrial fibrillation risk by ~27% versus placebo.
- HR 0.73
- 95% CI 0.56-0.94
- P=0.01
- n=17,120
Why the study?
Studies of statin therapy and incident AF had yielded mixed results and had not focused on individuals with an underlying pro-inflammatory response.
Does rosuvastatin 20 mg daily reduce incident atrial fibrillation in individuals with LDL cholesterol <130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L without prior arrhythmia?
Key Points
- This research investigates the association between high-sensitivity C-reactive protein and atrial fibrillation risk and assesses the effect of rosuvastatin on this relationship.
- Randomized trial involving men and women with LDL cholesterol <130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L.
- Participants were assigned to receive either rosuvastatin 20 mg daily or placebo.
- Incidence of atrial fibrillation was determined through treatment-blind adverse event reports.
- Each increasing tertile of baseline high-sensitivity C-reactive protein was associated with a 36% increase in AF risk (95% CI: 1.16-1.60; P-trend < 0.01).
- Rosuvastatin treatment reduced the risk of AF by 27% compared to placebo, with incidence rates of 0.78 vs. 0.56/100 person-years (HR: 0.73, 95% CI: 0.56-0.94, P = 0.01).
- Similar protective effects were observed even after excluding participants with prior major cardiovascular events.
Study Design
Type
RCT (n=17,120)
Blinding
Treatment-blind
Randomization
Randomized
Structured PICO
Does rosuvastatin 20 mg daily reduce incident atrial fibrillation in individuals with LDL cholesterol <130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L without prior arrhythmia?
P
Population
17,120 men and women with LDL cholesterol <130 mg/dL, high-sensitivity C-reactive protein ≥2 mg/L, and no prior arrhythmia, randomized to rosuvastatin or placebo.
I
Intervention
Rosuvastatin 20 mg daily
C
Comparator
Placebo
O
Outcome
Incident atrial fibrillation determined from treatment-blind adverse event reportshard clinical
Main Result
Hazard Ratio: 0.73 (95% CI 0.56–0.94)
Absolute Event Rate: 0.56% vs 0.78%
p-value: p=0.01
In individuals with elevated inflammation (hsCRP ≥2 mg/L) but normal LDL cholesterol, rosuvastatin 20 mg daily significantly reduces the risk of incident atrial fibrillation.
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The effect of rosuvastatin was not overwhelming. Statins are not very effective in my mind for preventing atrial fibrillation in patients with class II-IV heart failure.”
PMPaul M. RidkerDirector, Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital
“What drives cardiovascular disease is a combination of cholesterol and inflammation. But over the years we have shown statins can lower cholesterol and CRP.”
Implication
hsCRP predicts incident AF; rosuvastatin does not reduce AF incidence despite CRP lowering; leaves open targeted anti-inflammatory prevention.
Cite This Study
Peña et al. (2011) conducted an RCT in Atrial fibrillation (n=17,120). Rosuvastatin vs. Placebo was evaluated on Incident atrial fibrillation (HR 0.73, 95% CI 0.56-0.94, p=0.01). Rosuvastatin 20 mg daily significantly reduced the risk of incident atrial fibrillation compared with placebo (HR 0.73; 95% CI 0.56-0.94; P=0.01).