Cardiovascular outcome trial · N Engl J Med 2008
JUPITER trial
Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.
The bottom line
In apparently healthy people with normal LDL but elevated CRP, rosuvastatin significantly reduced major cardiovascular events and all-cause death, though with a higher rate of reported diabetes.
BenefitUS status: US-approved
At a glance
- Medicine
- Rosuvastatin, 20 mg daily
- Compared with
- Placebo
- People
- 17,802
- Who took part
- Apparently healthy men and women with LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher
- Design
- randomized, double-blind, placebo-controlled
- Follow-up
- median follow-up of 1.9 years (maximum, 5.0)
- Main question
- Combined end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes
Main result
The rates of the primary end point were 0.77 and 1.36 per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio for rosuvastatin, 0.56; 95% confidence interval [CI], 0.46 to 0.69; P<0.00001)
Effect on LDL cholesterol
Rosuvastatin reduced LDL cholesterol levels by 50%
Other results
1.00 and 1.25 for death from any cause (hazard ratio, 0.80; 95% CI, 0.67 to 0.97; P=0.02)
Safety
The rosuvastatin group did not have a significant increase in myopathy or cancer but did have a higher incidence of physician-reported diabetes.
In the trial's own words
“The rates of the primary end point were 0.77 and 1.36 per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio for rosuvastatin, 0.56; 95% confidence interval [CI], 0.46 to 0.69; P<0.00001)”
Quoted from the abstract of N Engl J Med 2008, checked word for word against PubMed. PubMed 18997196 · Full paper (DOI)
How this medicine works, where it stands and what it costs: Statins
Common questions
What did the JUPITER trial find?
In apparently healthy people with normal LDL but elevated CRP, rosuvastatin significantly reduced major cardiovascular events and all-cause death, though with a higher rate of reported diabetes.
Who was in JUPITER?
17,802 people. Apparently healthy men and women with LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher.
What was JUPITER's main result?
The rates of the primary end point were 0.77 and 1.36 per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio for rosuvastatin, 0.56; 95% confidence interval [CI], 0.46 to 0.69; P<0.00001)
How much did LDL cholesterol change in JUPITER?
Rosuvastatin reduced LDL cholesterol levels by 50%
Related trials
- CORONA (2007)In older patients with ischemic systolic heart failure, rosuvastatin lowered LDL cholesterol but did not reduce cardiovascular events or death, though it was safe and reduced cardiovascular hospitalizations.
- AURORA (2009)In patients on hemodialysis, rosuvastatin lowered LDL cholesterol but did not reduce cardiovascular events or all-cause mortality compared with placebo.
- SPARCL (2006)In patients with a recent stroke or TIA but no known coronary disease, high-dose atorvastatin modestly reduced recurrent stroke and cardiovascular events, though it slightly increased hemorrhagic stroke risk and did not improve overall mortality.
- IDEAL (2005)High-dose atorvastatin lowered LDL-C more than usual-dose simvastatin and reduced some secondary cardiovascular endpoints and nonfatal MI, but did not significantly reduce the primary composite of major coronary events or all-cause mortality after prior MI.
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