Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)—Can C-Reactive Protein Be Used to Target Statin Therapy in Primary Prevention?
Section snippets
Role of Inflammation in Cardiovascular Disease
Multiple large-scale prospective studies performed in a variety of populations have demonstrated that hs-CRP is a strong and independent predictor of CVD events, including myocardial infarction (MI), ischemic stroke, sudden cardiac death, and diabetes mellitus.11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 In the Physicians’ Health Study, an epidemiologic study of >22,000 healthy middle-aged men with no clinical evidence of disease, increasing levels of hs-CRP at study entry were associated
C-Reactive Protein–Lowering Effects of Statins in Acute Coronary Syndromes
Until recently, it was not known whether the hs-CRP–lowering action of statins provided any clinical benefit beyond their LDL cholesterol–lowering action. In 2 studies published recently—the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) and the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) studies—the strongest evidence to date is provided for the independent cardiovascular benefits associated
Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)
Because inflammation is an integral part of the underlying pathophysiology of atherosclerosis and hs-CRP is a useful clinical marker of this inflammatory process, an important unresolved question is whether hs-CRP screening combined with traditional lipid screening would provide an improved strategy for statin use in primary prevention of CVD. The JUPITER trial was designed to answer this question. Several factors governed the design. First, statin therapy has been repeatedly demonstrated to
Conclusion
The JUPITER trial is the first large-scale, multinational, double-blind, placebo-controlled clinical trial to investigate the effects of statins in the primary prevention of cardiovascular events in individuals with low levels of LDL cholesterol who may be at risk because of their elevated hs-CRP levels. Trial results could provide an evidence base for the use of hs-CRP in addition to LDL cholesterol to guide statin therapy in primary prevention. Because of its potential impact on public
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Cited by (0)
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Paul M Ridker is listed as a co-inventor on patents held by the Brigham and Women’s Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease.