Tuesday, November 11, 2008

Rosuvastatin in Low Risk Patients- The JUPITER study

This NEJM article may change the way we treat 'traditionally' low-risk patients.
In this prospective randomized, double-blinded, placebo-controlled study involving over 17000 patients, subjects were considered to be low risk using traditional criteria:
Men over 50 or women over 60 years, with no known coronary artery disease, with a screening LDL of <130>2 mg/L. Patients were randomized to placebo or Rosuvastatin 20 mg daily and the protocol had planned to follow patients for up to 60 months.
Primary endpoint was first major cardiovascular event, while secondary endpoints included death from any cause. The study was terminated after a median of 1.9 years after the safety monitoring commitee found significantly different rates of primary endpoints; 0.77 in the treatment group per 100 person-years, compared to 1.36 in the placebo group (hazard ratio 0.56, 95% CI 0.46-0.69; P<0.00001).

Which begs the question, what exactly should we be aiming for? Should CRP be something we be checking more frequently?I remember in residency, CRP is always talked about and yet because at that time no intervention has been showed to decrease the risk even in high-CRP patients it kinda fell out of favor, kinda like checking for homocysteine levels. This study, may however change some thinking.

On thing to bear in mind; although the relative risk reduction seems impressive, this was already a lower risk group. The authors do add that the number needed to treat to prevent 1 occurrence of the primary endpoint in 2 years is 95 patients. Therefore you treat 95 patients with an expensive statin to reduce the event in 1 patient; what is the cost vs benefits?

While I'd like to see this reproduced in other studies, this was a pretty well-designed study (albeit financially supported by Pharma) with a good number of subjects and fairly compelling results. I'm sure I'll be getting some requests from patients in the coming weeks to check their CRP levels.


Anonymous Anonymous said...

hi, a med student point of view.
1 in 95 ? Does a 1% difference in primary end point considered to be significant? I cant appreciate it though..

and i came across that Rosuvastatin does not improves mortality rate in patient with systolic heart failure
(not really related though)

Anyway, many thanks for posting this up

3:21 PM  
Anonymous Ronald said...

Makes me wonder, can the result of this study be reproduced when used with other statins i.e simvastatin, atorvostatin?


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