The Gravity of JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin)

James H. O'Keefe, Maia D. Carter, Carl J. Lavie, David S.H. Bell

In the recently published Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study, a large, randomized, placebo-controlled trial, rosuvastatin proved to be safe and remarkably effective in the setting of primary prevention. In patients without coronary heart disease or diabetes, with a baseline low-density lipoprotein cholesterol (LDL-C) level < 130 mg/dL and a C-reactive protein (CRP) > or = 2mg/L, a statin-induced LDL-C reduction of 50% reduced serious cardiac events by about 50%, including in women and the elderly, and also lowered all-cause mortality. The mean on-treatment LDL-C level (55 mg/dL) in the rosuvastatin arm of JUPITER was about in the mid-range of the physiologically normal levels. C-reactive protein screening should be considered, especially in patients without preexisting indications for statin therapy. In general, the CRP-lowering efficacy of statin therapy is directly and significantly correlated with its LDL-C-lowering activity. Simvastatin, at the 80-mg daily dose, is more toxic to muscles and liver than other statins at their highest dose, and thus should be used with caution.