Anti-inflammatory 20mg/day Rosuvastatin reduced C-reactive protein, heart attacks, strokes in people with normal LDL but elevated C-reactive protein

[sammmy]

A randomized placebo-controlled trial of the anti-inflammatory effect (reduction of C-reactive protein) of 20mg/day Rosuvastatin in the so called JUPITER trial in people with normal LDL, but elevated C-reactive protein:

https://www.nejm.org/doi/full/10.1056/NEJMoa0807646

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=0.0002), 0.18 and 0.34 for stroke (hazard ratio, 0.52; 95% CI, 0.34 to 0.79; P=0.002), 0.41 and 0.77 for revascularization or unstable angina (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.00001), 0.45 and 0.85 for the combined end point of myocardial infarction, stroke, or death from cardiovascular causes (hazard ratio, 0.53; 95% CI, 0.40 to 0.69; P<0.00001), and 1.00 and 1.25 for death from any cause (hazard ratio, 0.80; 95% CI, 0.67 to 0.97; P=0.02). Consistent effects were observed in all subgroups evaluated. The rosuvastatin group did not have a significant increase in myopathy or cancer but did have a higher incidence of physician-reported diabetes.

It is interesting to see if the reduction in heart attacks and strokes is dose dependent or it can be achieved at the lowest dose 5mg/day with less side effects (new physician reported diabetes was more frequent in the Rosuvastatin group).

Rosuvastatin is a water-soluble statin and is not associated with increased risk for dementia, unlike the fat-soluble statins.

 

[sammmy]

Summary for the less scientifically inclined:

Statin Therapy for Elevated hsCRP: What Are the Public Health Implications?

Randomized trial data indicate that heart disease risk associated with elevated hsCRP can be cut by almost half with a safe, proven pharmacologic therapy.

www.ajmc.com

In brief, the 18,000-participant JUPITER trial overwhelmingly confirmed (1) that those with elevated hsCRP are at substantially elevated vascular risk despite low LDL-C levels and low Framingham Risk Scores and (2) that in this setting rosuvastatin 20 mg compared with placebo reduced the risk of myocardial infarction by 55%, stroke by 48%, bypass surgery and revascularization by 46%, deep vein thrombosis by 43%, and total mortality by 20%.7-9 These hard clinical benefits were statistically significant in all subgroups evaluated, including women, minorities, and the elderly, groups that in the past had been understudied in major trials. Overall, the 5-year number needed to treat (NNT) was 25, a value smaller than that already considered to be effective in primary prevention for those with hyperlipidemia and substantially more efficient that the comparable NNT value for the treatment of hypertension.