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World J Cardiol. Dec 31, 2009; 1(1): 41-45
Published online Dec 31, 2009. doi: 10.4330/wjc.v1.i1.41
Key questions resulting from the JUPITER trial assessing cardiovascular disease intervention with rosuvastatin
Shirya Rashid
Shirya Rashid, Department of Medicine, McMaster University, Henderson Research Centre, Hamilton, Ontario, L8V 1C3, Canada
Author contributions: Rashid S solely contributed to this paper.
Supported by Grants from Hamilton Health Sciences, the Canadian Institutes of Health, AstraZeneca and Merck Frosst Schering, A Department of Medicine McMaster University Internal Career Award
Correspondence to: Dr. Shirya Rashid, PhD, Department of Medicine, McMaster University, Henderson Research Centre, Room 206, G-Wing, 711 Concession Street, Hamilton, Ontario, L8V 1C3, Canada.
Telephone: +1-905-5272299-43780 Fax: +1-905-5752646
Received: December 22, 2009
Revised: December 27, 2009
Accepted: December 28, 2009
Published online: December 31, 2009

This paper presents an analysis of the recently published Justification for the Use of statins in Prevention (JUPITER: an intervention trial evaluating rosuvastatin) trial, which tested the statin rosuvastatin in apparently healthy individuals with no prior cardiovascular (CVD) disease and with normal plasma low density lipoprotein (LDL) cholesterol concentrations but with raised plasma high sensitivity C-reactive protein (hsCRP) levels. The rate of the combined primary CVD endpoint was significantly reduced in the treatment arm after a median of under 2 years. The JUPITER trial is distinct from previous studies examining statin use in primary prevention groups because the target group for drug therapy was apparently healthy men and women at low or intermediate risk for developing CVD. On the basis of JUPITER’s findings, there are key questions that should be assessed on the therapeutic intervention of CVD regarding: the primary prevention groups that should be targeted for statin therapy, the utility of targets in addition to plasma LDL cholesterol levels, and the need to consider the metabolic state of individuals targeted for therapy (including the presence of obesity and inflammation). The conclusion from the current analysis is that the JUPITER results warrant further LDL cholesterol lowering than is currently targeted in primary prevention groups that have a pre-existing condition or lifestyle that elevates CVD risk but still do not have a high global CVD risk (as assessed with current algorithms). This group is not captured in current widely used CVD risk calculations, however, with the identification of useful biomarkers, such as hsCRP, this group can be better identified and targeted for intervention.

Keywords: Statin, C-Reactive Protein, Low density lipoprotein cholesterol, Inflammation, Cardiovascular diseases