Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial.

Description

A subanalysis of the JUPITER trial examined whether achieving lower C-reactive protein (CRP) concentrations after initiation of statin therapy is associated with improved clinical outcomes in a similar manner as achieving lower LDL cholesterol concentrations The reduction in vascular events was 55% (p<0.0001) in participants on rosuvastatin who achieved LDL cholesterol <1.8 mmol/l and 62% (p<0.0001) in participants who achieved CRP <2 mg/l compared to placebo. The reduction in vascular events was 65% in patients on rosuvastatin who simultaneously achieved LDL cholesterol <1.8 mmol/l and CRP <2 mg/l and 33% in those who achieved only one or neither target. When CRP concentrations were further reduced to <1 mg/l in combination with LDL cholesterol <1.8 mmol/l, the reduction in vascular events was 79%. The study’s authors concluded that in individuals who chose to initiate pharmacological prophylaxis, reductions in LDL cholesterol and CRP concentrations are indicators of the success of treatment with statin therapy. In his editorial, Després JP recognized that this subanalysis of the JUPITER trial provided proof-of-concept support to the lipid-inflammation target. The JUPITER subanalysis also suggested that we need to do a better job in terms of global cardiovascular disease risk assessment. However, the editorial also called for the results of this important study to be put into proper clinical and public health perspective. Before recommending statin treatment in primary prevention on a large-scale basis, we have to recognize that we live in a “toxic” environment that largely contributes to the deterioration of the cardiovascular risk profile. Most importantly, this atherogenic, pro-inflammatory environment can be modified.