Once again, a statin was clearly effective for primary prevention of cardiovascular events, but using CRP levels to determine treatment thresholds remains debatable.
16 nov 2008--High-sensitivity C-reactive protein, a biomarker of inflammation, independently predicts cardiovascular events. To find out whether treatment with rosuvastatin might decrease the rate of first major cardiovascular events in apparently healthy individuals, investigators for the manufacturer-sponsored Justification for the Use of Statins in Prevention: an Interventional Trial Evaluating Rosuvastatin (JUPITER) studied subjects who had high-sensitivity CRP levels 2 mg/L but not high cholesterol levels (LDL levels
The study incorporated a diverse population (38.2% were women; 25.2% were black or Latino); 16.6% of participants took aspirin. When the study was terminated, 75% of participants were taking their assigned medications. In the rosuvastatin group, the median LDL level at 12 months was 55 mg/dL, and the mean high-sensitivity CRP level was 2.2 mg/L; in the placebo group, the median LDL level was 110 mg/dL and the median high-sensitivity CRP level was 3.5 mg/L. Overall, the rate of the primary endpoint was 0.77 per 100 person-years of follow-up in the rosuvastatin group and 1.36 per 100 person-years in the placebo group ( P <0.00001).>
Comment: In JUPITER, statin therapy clearly was associated with significant reductions in relative risk for cardiovascular events. However, as noted in an accompanying editorial, when we weigh the costs and benefits of drug therapy, absolute differences in risk are more important than are relative differences. The results of JUPITER are inconclusive in regard to the value of high-sensitivity CRP testing in clinical care. At this time, no change is warranted to current guidelines recommending selective measurement of high-sensitivity CRP in asymptomatic patients at an intermediate level of risk based on standard clinical markers.