Jupiter study
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Introduction
Study characteristics:
- industry-sponsored study
- 18,000 subjects
- men >= 50 years
- women >= 60 years
- without known cardiovascular disease
- LDL cholesterol < 130 mg/dL
- serum CRP >= 2 mg/L
Exclusion criteria (extensive)
- diabetes
- uncontrolled hypertension
- cholesterol-lowering medications
Treatment:
- rosuvastatin 20 mg QD vs placebo
Primary endpoint:
- 1st major cardiovascular event
- myocardial infarction, unstable angina, stroke, arterial revascularization, death from cardiovascular cause
Results:
- median follow-up = 1.9 years
- study stopped early because of markedly positive results in favor of rosuvastatin
- rosuvatation lowered LDL cholesterol by a mean of 50%
- rosuvatation lowered serum CRP by a mean of 37%
- primary endpoint less frequent in rosuvastatin group; hazzard ratio 0.56
- mortality lower in rosuvastatin group; hazzard ratio 0.8
- for every 1000 patients who received rosuvastatin for 1 year, 6 fewer major cardiovascular events & 3 fewer deaths
- incidence of diabetes significantly higher in rosuvastatin group
- median hemoglobin A1c higher in rosuvastatin group
- subgroup of elderly > 70 years of age (< 25% > 77)
- lower rate of occurrence of major cardiovascular events in rosuvastatin group 1.22 vs 1.99 per 100 person years)
- lower all cause mortality in rosuvastatin group (1.64 vs 2.04 per 100 person years) not statistically significant
- serious adverse effects, muscular symptoms, new diabetes, GI, renal and hepatic complications more common in rosuvastatin group, but not significantly
- benefit of rosuvastatin absent in participants without hypertension
Notes
- major discrepancy between significant reduction in nonfatal stroke & myocardial infarction, but no effect on mortality[5]
- cardiovascular mortality was low (5-18%) compared with total mortality (expected ~ 40%)[5]
- absolute size effect small (per editorialist)
- incidence of diabetes worrisome (per editorialist)
- industry-sponsored study stopped early is suspect
- financial incentives appear to be substantial
- results do not support the use of statins for primary prevention of cardiovascular disease[5]
More general terms
Additional terms
References
- ↑ Ridker PM et al Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008, 359:2195 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18997196
- ↑ Hlatky MA Expanding the orbit of primary prevention - Moving beyond Jupiter N Engl J Med 2008, 359:2280 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18997195
- ↑ Spatz ES et al From here to JUPITER: Identifying new patients for statin therapy using data from the 1999-2004 National Health and Nutrition Examination Survey. Circ Cardiovasc Qual Outcomes 2009 Jan; 2:41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20031811
Despres JP. Bringing JUPITER down to earth. Lancet. 2009 Apr 4;373(9670):1147-8. Epub 2009 Mar 28. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19329179
Kritek P, Campion EW. JUPITER clinical directions--polling results. N Engl J Med. 2009 Mar 5;360(10):e14. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19264683
Nissen SE. The Jupiter trial: key findings, controversies, and implications. Curr Cardiol Rep. 2009 Mar;11(2):81-2. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19236822
Fuster V, Bansilal JUPITER strikes earth. Nat Clin Pract Cardiovasc Med. 2009 Mar;6(3):159. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19234496 - ↑ Glynn RJ et al. Rosuvastatin for primary prevention in older persons with elevated C-reactive protein and low to average low-density lipoprotein cholesterol levels: Exploratory analysis of a randomized trial. Ann Intern Med 2010 Apr 20; 152:488. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20404379
Zieman SJ and Ouyang P. Statins for primary prevention in older adults: Who is at high risk, who is old, and what denotes primary prevention? Ann Intern Med 2010 Apr 20; 152:528. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20404384 - ↑ 5.0 5.1 5.2 5.3 de Logeril M et al Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy Arch Intern Med. 2010;170(12):1032-1036 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20585068 <Internet> http://archinte.ama-assn.org/cgi/content/short/170/12/1032