This study will change our thinking.  This study will change primary cardiac prevention.  This study gives us wonderful clues, but we need more data.

Probably sentence #3 is the most accurate, but the Jupiter study should change our conversation.  Statin use ‘may benefit healthy’

The results are published in the New England Journal of Medicine.

The patients in the trial, funded by AstraZeneca, had cholesterol levels below those usually indicating a need for treatment and had no other signs of heart disease.

But they did have increased levels of a C-reactive protein, which indicates inflammation in the body and is believed to be a marker of future cardiovascular events.

After an average follow-up of two years, 20mg a day of rosuvastatin was found to have cut cholesterol by 50% and C-reactive protein by 37%.

Overall, the chance of a heart attack, stroke, hospital admission for chest pain or death from cardiovascular disease was cut by 44%, researchers said.

A reduction was even seen in those with the lowest chance of a cardiovascular event over the next decade, they said.

Researchers found a higher incidence of physician-reported diabetes in the statin group but could not explain it as blood glucose levels were similar between those taking rosuvastatin and those taking a dummy pill.

The NEJM released this article today (I received an email this morning.)  While I have not had time to read the article, I did peruse the editorial and read the abstract.  This article actually fits my current conceptualization of statins.

AHA: JUPITER Results Point to Role of Statins for ‘Apparently Healthy’ Patients

All participants had elevated highly sensitive CRP, defined as 2.0 mg/L or higher, and here, too, the results were impressive — an average reduction of 37%.

Moreover, the results were quite different from those of trials that recruited on the basis of elevated LDL.

Those trials "generally reported a 20% reduction in vascular risk for each 1 mmol/L (38.7 mg/dL) absolute reduction in the LDL cholesterol level, an effect that would have predicted a proportional reduction in the number of events in our study of approximately 25%," the investigators wrote.

"However, the reduction in the hazard seen in our trial, in which enrollment was based on elevated high-sensitivity C-reactive protein levels rather than on elevated LDL cholesterol levels, was almost twice this magnitude and revealed a greater relative benefit than that found in most previous statin trials," they added.

The number needed to treat with rosuvastatin for two years to prevent the occurrence of one primary event was 95 and the number needed to treat for four years to prevent one primary event was 31.

If the risks were projected over five years, as is usually done in statin trials, the number needed to treat to prevent a primary endpoint drops to 25.

While statin development focused on LDL lowering, more recent data have supported the importance of plaque stabilization.  The better results in this risk group than previous studies based on LDL levels seems to support the inflammatory hypothesis rather than the cholesterol hypothesis.

Now we should be somewhat cautious with this study, but I still find it remarkable.  We may start measuring CRP levels to pick those patients who deserve prevention with statins.  Of course this drug company funded study only studied one expensive statin.  We do not really know if the current generics would do as well.

Fascinating!

Related posts:

1. Wherefore statins?
2. More on the new cholesterol guidelines
3. Defining secondary prevention
4. Thoughts on universal health care
5. Statins for diabetes

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