1. The JUPITER Trial Reference Ridker PM. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–2207. Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin

2. Background Increased levels of high-sensitivity C-reactive protein is a predictor of cardiovascular diseases. Statin therapy reduces the high-sensitivity C-reactivity protein levels in healthy patients and in patients with stable coronary disease. So the hypothesis was made that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin therapy.

3. Aim To investigate whether treatment with Rosuvastatin would decrease the rate of first major cardiovascular events.

4. Method Study design: The JUPITER trial was a randomized, double blind, placebo- controlled, multicenter trial. Study population: A total of 17,802 subjects (male <50 years and female <60 years of age) were included if they did not have a previous history of cardiovascular diseases and if they had a LDL level <130 mg/dL and a high-sensitivity C-reactive protein level of 2.0 mg/L or more. The exclusion criteria was previous or current use of lipid-lowering therapy, use of post-menopausal hormone replacement therapy, hepatic dysfunction, diabetes, uncontrolled hypertension, cancer (in the past 5 years prior to enrollment), uncontrolled hypothyroidism and recent history of alcohol or drug abuse. Patients with inflammatory conditions and those taking immunosuppressant agents were also excluded from the study.

5. Dosage regimen: The patients were randomly assigned into two groups. The first one was given Rosuvastatin 20 mg/day and the other was administered placebo. The follow-up visits were scheduled at 13 weeks and then at 6, 12, 18, 24, 30, 36, 42, 48, 54 and 60 months. End point: The primary outcome was occurrence of first major cardiovascular event defined as non-fatal myocardial infarction, non-fatal stroke and hospitalization for unstable angina, arterial revascularization procedures or death from cardiovascular reasons.

6. Results At the end of the study, 142 first major cardiovascular events have occurred in the Rosuvastatin group as compared to 251 in the placebo group. On the basis of the Kaplan–Meier estimates, the number of patients who would need to be treated with Rosuvastatin for 2 years to avoid a primary end point is 95. Rosuvastatin group also showed significant reductions in the risk of individual components of the primary end point. The occurrence rates for fatal and non-fatal myocardial infarction were -0.17 and 0.37 per 100 person-years of follow-up in the Rosuvastatin and placebo group, respectively. The rates for fatal and non-fatal stroke were 0.18 and 0.34, respectively, for arterial revascularization or unstable angina. The rates for fatal and non-fatal stroke were 0.41 and 0.77, and 0.45 and 0.85, respectively, for the combined end point of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes. The death rates from any cause were 1.00 and 1.25 per 100 person-years in the Rosuvastatin and placebo groups, respectively.

10. Conclusion The JUPITER study showed that Rosuvastatin reduced the elevated levels of high-sensitivity C-reactive protein and reduced the incidence of a major cardiovascular event in apparently healthy subjects. Rosuvastatin was also found to significantly reduce incidence of death from any cause. Most importantly these effects were consistent over all subgroups. Rosuvastatin reduced the elevated levels of high-sensitivity C-reactive protein, hence reducing the incidence of a major cardiovascular events or death.