Relation of baseline high-sensitivity C-reactive protein level to cardiovascular outcomes with rosuvastatin in the Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER).
Level 2 - randomized trial
Secondary analysis of an individual randomized controlled trial
PubMed 20599004 · doi:10.1016/j.amjcard.2010.03.018
What was done
This was an analysis of the randomized controlled JUPITER trial, which evaluated rosuvastatin versus placebo in primary prevention patients with LDL cholesterol <130 mg/dl and high-sensitivity C-reactive protein (hs-CRP) >=2 mg/L. The authors evaluated the relationship between baseline hs-CRP levels (as continuous, ordinal, and threshold variables) and vascular risk, as well as treatment efficacy across hs-CRP strata.
What was found
In the parent trial, rosuvastatin reduced major vascular events by 44%. Within JUPITER, higher baseline hs-CRP levels were associated with increasing vascular risk across continuous, ordinal, and threshold analyses. Relative risk reduction with rosuvastatin was similar across baseline hs-CRP tertiles and thresholds, resulting in the greatest absolute risk reduction in patients with the highest baseline hs-CRP. Specific numerical event rates, hazard ratios, and confidence intervals were not provided in the abstract.
Why it matters
These findings show that hs-CRP remains a continuous marker of cardiovascular risk even in a restricted-range cohort, with the highest baseline inflammation deriving the greatest absolute benefit from rosuvastatin.
Limits
The abstract does not report the sample size, numerical risk estimates, or confidence intervals. The study population was restricted to patients with low LDL-C (<130 mg/dl) and elevated hs-CRP (>=2 mg/L), limiting generalizability to populations outside these criteria.
Cited by
- contradicts In the JUPITER trial, individuals with high LDL cholesterol but low inflammatory markers had lower cardiovascular risk than those with both high LDL and high inflammation.