Statin beneficial to intermediate-risk patients, says new JUPITER analysis

Rosuvastatin is beneficial as primary prevention for patients who are at intermediate risk of a cardiac event and have elevated C-reactive protein (CRP), according to the latest analysis of JUPITER.

JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin) included more than 17,000 patients who had cholesterol under 130 mg/dL and CRP of 2 mg/L or above. Evaluation of those patients using the Framingham risk score indicated that about 6,000 had a 10-year risk of a cardiac event of 5% to 10%. Another 7,340 patients had a Framingham risk of 11% to 20%. This new analysis assessed the effect of rosuvastatin, 20 mg, versus placebo on these intermediate-risk patients. The results were published online last week by Circulation: Cardiovascular Quality and Outcomes.

Patients with a 5% to 10% Framingham risk were 45% less likely to have an event if they took the drug (P=0.005) and those with a 10% to 20% risk had a 49% reduction in events (P<0.0001). That worked out to a 5-year number needed to treat of 40 for the 5% to 10% group and 18 for the 10% to 20% group. The researchers also tried stratifying the study population based on the Reynolds Risk score (which includes family history and CRP) and found similar results, except that more patients were considered lower or higher risk.

The results support the recommendations of the American Heart Association and the Centers for Disease Control and Prevention that CRP is best used in patients with a 10-year risk between 5% and 20%, the study authors said. If these patients are found to have elevated CRP, they might well be considered candidates for statin therapy, the authors suggested, noting that this group is currently outside treatment guidelines. Patients with even lower risk (less than 5% over 10 years) were found to receive only small benefit from statin treatment.

Recent Canadian guidelines have called for prophylactic statins for older patients with elevated CRP and Framingham scores above 10%. This approach is supported by the new findings, but it is limited by its exclusion of patients with a risk between 5% and 10%, the study authors said. Their analysis found that most women in JUPITER who benefited from taking a statin were in this 5% to 10% group, so they advocated expanding the definition of intermediate risk to include these patients.