JUPITER : reduction by rosuvastatin of cardiovascular events and mortality in healthy subjects without hyperlipidaemia but with elevated c-reactive protein

peer reviewedSUMMARY : High levels of high-sensitivity C-reactive protein (hs-CRP) are an independent cardiovascular marker, which may be reduced by statin therapy. JUPITER is a randomised clinical trial that compares the effects of rosuvastatin 20 mg (n = 8901) and placebo (n = 8901) in apparently healthy individuals, without hyperlipidaemia (LDL 2 mg/l ; median 4.25 mg/l). Rosuvastatin reduced LDL cholesterol by 50 % (to a median of 55 mg/dl) and hs-CRP by 37 %. The trial, which should last 5 years, was stopped after a median follow-up of 1.9 years because of an imbalance in favour of the rosuvastatin group. Indeed, when compared to placebo, rosuvastatin was associated with a relative risk reduction in the composite primary end point of 44 %, in myocardial infarction of 54 %, in stroke of 48 %, in revascularization procedures or hospitalisations for unstable angina of 47 %, in major cardiovascular events (myocardial infarction, stroke and death) of 47 % and in deaths from any cause of 20 %. Consistent effects were observed in all subgroups evaluated. The only adverse event was a higher incidence of physician-reported diabetes in the rosuvastatin group compared to the placebo group. This study demonstrates that rosuvastatin 20 mg reduces the incidence of cardiovascular events, including total mortality, in apparently healthy persons without hyperlipidaemia, but with elevated hs-CRP. However, the design of the trial does not allow discriminating which part of the favourable effect results from the drastic reduction in LDL cholesterol and which part results from the reduction in hs-CRP stricto sensu