QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: CLINICAL RESEARCH: TREATMENT IMPLICATIONS OF THE JUPITER TRIAL
Clinical Implications of JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) in a U.S. PopulationInsights From the ARIC (Atherosclerosis Risk in Communities) Study
Eric Y. Yang, MD*, ,
Vijay Nambi, MD*,,
Zhengzheng Tang, MS ,
Salim S. Virani, MD*,,
Eric Boerwinkle, PhD ,
Ron C. Hoogeveen, PhD*,,
Brad C. Astor, PhD||,
Thomas H. Mosley, PhD¶,
Josef Coresh, MD, PhD||,
Lloyd Chambless, PhD and
Christie M. Ballantyne, MD*,,*
* Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, Texas
Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
Human Genetics Center and Institute of Molecular Medicine, University of Texas-Houston Health Science Center, Houston, Texas
Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
|| Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
¶ University of Mississippi Medical Center, Jackson, Mississippi
Manuscript received July 13, 2009;
revised manuscript received September 23, 2009,
accepted October 12, 2009.
* Reprint requests and correspondence: Dr. Christie M. Ballantyne, Baylor College of Medicine, Methodist Debakey Heart and Vascular Center, 6565 Fannin Street, STE B160/M.S. A-601, Houston, Texas 77030 (Email: cmb{at}bcm.tmc.edu).
Objectives: The purpose of this study is to describe the proportion of "JUPITER-eligible" (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) individuals and clinical outcomes of individuals based on high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C) strata in the ARIC (Atherosclerosis Risk in Communities) study.
Background: Questions remain after the JUPITER study, including whether the observed cardiovascular disease (CVD) event rates would persist with time and how these event rates would compare with other populations (lower hs-CRP and/or higher LDL-C levels).
Methods: After stratification into 4 groups based on LDL-C and hs-CRP levels, with cutoffs at 130 mg/dl and 2.0 mg/l, respectively, incident CVD events were examined (mean follow-up, 6.9 years) and compared.
Results: Of 8,907 age-eligible participants, 18.2% (n = 1,621) were JUPITER-eligible (hs-CRP  2.0 mg/l, LDL-C <130 mg/dl) and had an absolute CVD risk of  10.9% over a mean follow-up of 6.9 years (1.57% per year). If JUPITER hazard ratios were applied to this group, the number needed to treat to prevent 1 CVD event would be estimated at 38 over 5 years and 26 over 6.9 years.
Conclusions: ARIC participants with elevated hs-CRP and low LDL-C had a CVD event rate of 1.57% per year over 6.9 years, similar to the CVD event rate noted in the JUPITER study placebo group (1.36% per year over 1.9 years). The association of hs-CRP 2.0 mg/l with increased CVD risk and mortality regardless of LDL-C provides us a simple method of using age and hs-CRP level for identifying higher risk individuals. (Atherosclerosis Risk in Communities study; NCT00005131)
Key Words: hs-CRP • LDL-C • ARIC • lipids • cardiovascular disease
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Abbreviations and Acronyms
| | CHD = coronary heart disease | | CVD = cardiovascular disease | | hs-CRP = high-sensitivity C-reactive protein | | LDL-C = low-density lipoprotein cholesterol | | MACE = major adverse cardiovascular event | | MI = myocardial infarction | | PVD = peripheral vascular disease |
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