Rosuvastatin Prevents Cardiovascular Events

new england

journal of medicine

The

established in 1812

november 20, 2008

vol. 359  no. 21

Rosuvastatin to Prevent Vascular Events in Men and Women

with Elevated C-Reactive Protein

Paul M Ridker, M.D., Eleanor Danielson, M.I.A., Francisco A.H. Fonseca, M.D., Jacques Genest, M.D.,

Antonio M. Gotto, Jr., M.D., John J.P. Kastelein, M.D., Wolfgang Koenig, M.D., Peter Libby, M.D.,

Alberto J. Lorenzatti, M.D., Jean G. MacFadyen, B.A., Børge G. Nordestgaard, M.D., James Shepherd, M.D.,

James T. Willerson, M.D., and Robert J. Glynn, Sc.D., for the JUPITER Study Group*

A bs t r ac t

Background

Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein

predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive

protein as well as cholesterol, we hypothesized that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin

treatment.

Methods

We randomly assigned 17,802 apparently healthy men and women with low-density

lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per

liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to

rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the

combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes.

Results

The trial was stopped after a median follow-up of 1.9 years (maximum, 5.0). Rosuvastatin reduced LDL cholesterol levels by 50% and high-sensitivity C-reactive protein

levels by 37%. The rates of the primary end point were 0.77 and 1.36 per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard

ratio for rosuvastatin, 0.56; 95% confidence interval [CI], 0.46 to 0.69; P<0.00001), with

corresponding rates of 0.17 and 0.37 for myocardial infarction (hazard ratio, 0.46; 95%

CI, 0.30 to 0.70; P   ...