A large trial of the cholesterol lowering drug rosuvastatin (Crestor from AstraZeneca) showed that giving it to healthy adults reduced their risk of blood clots (venous thromboembolism) by 43 per cent.
This was the result of a subgroup analysis in the JUPITER trial, and was published online on 28 March in The Lancet and presented at the American College of Cardiology’s 58th Annual Scientific Sessions by Dr Robert J Glynn of the Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA.
The JUPITER trial stopped 2 years early because the benefits were so pronounced.
The most important result of this part of the trial, according to to an editor’s note accompanying the published study, is that the amount of protection statins give non-cardiac patients depends on how low the LDL (Low-density lipoprotein, or “bad” cholesterol) levels become: since lower LDL was linked to smaller risk of vascular events.
This effect was magnified by the level of hsCRP (high sensitivity C reactive protein, a marker for inflammation) achieved, with lower hsCRP providing even greater protection from vascular events, even in participants with low LDL.
This study therefore shows that the lipid-lowering and anti-inflammatory properties of statins are important.
The analysis included 15,548 healthy men and women taking part in the JUPITER trial (87 per cent of the total participants) who had been randomly assigned to take placebo or 20 mg a day of rosuvastatin (Crestor).
The results showed that:
- Compared with placebo, men and women on rosuvastatin whose LDL fell below 1·8 mmol/L had a 55 per cent reduction in vascular events.
- Those whose hsCRP fell below 2 mg/L had a 62 per cent reduction in vascular events.
- LDL cholesterol and hsCRP reductions were only weakly correlated in individual patients.
- But there was a 65 per cent reduction in vascular events in men and women in the rosuvastatin group whose LDL went below 1·8 mmol/L and whose hsCRP was less than 2 mg/L.
- This compared to only a 33 per cent reduction in those who achieved reduction in only one or neither of the two markers.
- In participants whose LDL went lower than 1·8 mmol/L and whose hsCRP fell below 1 mg/L, there was a 79 reduction in vascular events.
- Achieved hsCRP levels predicted rates of vascular events regardless of which lipid outcome measure the researchers used, including ratio of apolipoprotein B to apolipoprotein AI.
The researchers concluded that:
“For people choosing to start pharmacological prophylaxis, reduction in both LDL cholesterol and hsCRP are indicators of successful treatment with rosuvastatin.”
According to Cardiology Today, Glynn said that rosuvastatin was linked to a “clear clinical benefit in the absence of any bleeding hazard”.
“Widening the treatment target to include prevention of VTE and death in addition to arterial thrombosis increases the estimated benefit of statin use,” he added.
More than 90 per cent of the vascular events occurred in participants before they experienced a CV event.
The trial was funded by AstraZeneca.
“Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial.”
Paul M Ridker, Eleanor Danielson, Francisco AH Fonseca, Jacques Genest, Antonio M Gotto Jr, John JP Kastelein, Wolfgang Koenig, Peter Libby, Alberto J Lorenzatti, Jean G MacFadyen, Børge G Nordestgaard, James Shepherd, et al.
doi:10.1016/S0140-6736(09)60447-5
Sources: Journal article, Cardiology Today.
Written by: Catharine Paddock, PhD