The JUPITER study, presented at the American College of Cardiology (ACC) meeting in New Orleans, has generated significant interest for its findings on the use of statins in patients with low LDL-C but elevated CRP levels. The trial focused on rosuvastatin and revealed that it could reduce the risk of major cardiovascular events—such as heart attacks, strokes, unstable angina, vascular revascularization, and cardiovascular death—by 44% in this group. Despite these promising results, some experts argue that it may be premature to revise current treatment guidelines based solely on this study.
It’s well known that a significant number of heart attacks and strokes occur in individuals who appear healthy and have average or low LDL-C levels. High-sensitivity C-reactive protein (hsCRP) is a key marker of inflammation and independently predicts future cardiovascular events. This makes it a valuable tool for identifying patients at higher risk. Statins are not only effective at lowering cholesterol but also have anti-inflammatory properties, which may contribute to their protective effects beyond lipid reduction.
A 2001 study found that people with low LDL-C but high hsCRP had similar risk levels to those with high cholesterol, suggesting that statin therapy might be beneficial even in this subgroup. The JUPITER trial was designed to test this hypothesis further. It included 17,802 participants from 216 countries—men over 50 and women over 60—who had LDL-C below 130 mg/dl and hsCRP above 2.0 mg/L. These individuals did not have existing cardiovascular disease or diabetes.
Participants were randomly assigned to receive either 20 mg/day of rosuvastatin or a placebo. After the study, LDL-C levels dropped by 50%, reaching an average of 55 mg/dl, and hsCRP levels decreased by 37%. The primary endpoint—heart attack, stroke, revascularization, hospitalization for unstable angina, or cardiovascular death—occurred in 0.77% of the rosuvastatin group versus 1.36% in the placebo group. The hazard ratio was 0.56, showing a clear benefit.
Lead researcher Dr. Paul Ridker from Harvard Medical School emphasized the cost-effectiveness of using rosuvastatin for primary prevention. He noted a 47% reduction in hospitalizations and revascularizations during follow-up, suggesting that the JUPITER approach could be both effective and economically viable. Additionally, among 6,375 participants with no other risk factors besides elevated hsCRP, the first event rate dropped by 37%, reinforcing the link between inflammation and coronary risk.
In terms of safety, rosuvastatin was generally well-tolerated. No significant differences were observed in muscle-related side effects such as myopathy or rhabdomyolysis. Notably, cancer deaths were lower in the rosuvastatin group (35 vs. 58), though there was no difference in overall cancer incidence. However, more cases of new-onset diabetes were reported in the rosuvastatin group (245 vs. 196), consistent with previous statin trials.
The exact mechanism by which rosuvastatin reduces CRP and lowers event rates remains unclear. However, all statins have both lipid-lowering and anti-inflammatory effects, and rosuvastatin appears to be particularly potent in both areas.
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