Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein Export

@article{citeulike:3504037, abstract = {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=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. Conclusions In this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events. (ClinicalTrials.gov number, NCT00239681 .) 10.1056/NEJMoa0807646}, author = {Ridker, Paul M. and Danielson, Eleanor and Fonseca, Francisco A. H. and Genest, Jacques and Gotto, Antonio M. and Kastelein, John J. P. and Koenig, Wolfgang and Libby, Peter and Lorenzatti, Alberto J. and MacFadyen, Jean G. and Nordestgaard, Borge G. and Shepherd, James and Willerson, James T. and Glynn, Robert J. and the JUPITER Study Group}, citeulike-article-id = {3504037}, citeulike-linkout-0 = {http://dx.doi.org/10.1056/NEJMoa0807646}, citeulike-linkout-1 = {http://content.nejm.org/content/359/21/2195.abstract}, citeulike-linkout-2 = {http://content.nejm.org/content/359/21/2195.full.pdf}, citeulike-linkout-3 = {http://content.nejm.org/cgi/content/abstract/359/21/2195}, citeulike-linkout-4 = {http://view.ncbi.nlm.nih.gov/pubmed/18997196}, citeulike-linkout-5 = {http://www.hubmed.org/display.cgi?uids=18997196}, day = {20}, doi = {10.1056/NEJMoa0807646}, issn = {1533-4406}, journal = {N Engl J Med}, keywords = {crp, inflammation, jupiter}, month = {November}, number = {21}, pages = {2195--2207}, posted-at = {2009-08-21 15:17:19}, priority = {2}, title = {Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein}, url = {http://dx.doi.org/10.1056/NEJMoa0807646}, volume = {359}, year = {2008} }

TY - JOUR ID - citeulike:3504037 L3 - citeulike-article-id:3504037 N2 - 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=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. Conclusions In this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events. (ClinicalTrials.gov number, NCT00239681 .) 10.1056/NEJMoa0807646 IS - 21 JF - N Engl J Med SN - 1533-4406 EP - 2207 TI - Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein VL - 359 SP - 2195 KW - crp KW - inflammation KW - jupiter AU - Ridker, Paul AU - Danielson, Eleanor AU - Fonseca, Francisco AU - Genest, Jacques AU - Gotto, Antonio AU - Kastelein, John AU - Koenig, Wolfgang AU - Libby, Peter AU - Lorenzatti, Alberto AU - MacFadyen, Jean AU - Nordestgaard, Borge AU - Shepherd, James AU - Willerson, James AU - Glynn, Robert AU - the JUPITER Study Group PY - 2008/11/20/ UR - http://dx.doi.org/10.1056/NEJMoa0807646 ER -