How Low to Go for Primary Prevention?
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CLINICAL TRIAL REPORT
How Low to Go for Primary Prevention? Jennifer G. Robinson
Published online: 29 April 2010 # Springer Science+Business Media, LLC 2010
Ridker PM, MacFadyen JG, Fonseca FAH, et al.: Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated highsensitivity C-reactive Protein: Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER). Circ Cardiovasc Qual Outcomes 2009, 2:616–623.
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(CRP), and LDL-C level below the recommended treatment threshold of 130 mg/dL for persons without cardiovascular disease or diabetes [2].
Aims The JUPITER investigators undertook this analysis to determine whether application of the JUPITER eligibility criteria would justify wide application of statin therapy in primary prevention.
• Of importance. Methods Introduction Current US cholesterol treatment guidelines recommend treatment intensity based on the level of cardiovascular risk, as assessed by the presence of cardiovascular disease, diabetes, or level of risk factors in those free of clinical disease [1]. The Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) found that rosuvastatin therapy lowered lowdensity lipoprotein cholesterol (LDL-C) by 50% and reduced cardiovascular events by 44% in individuals who would not be candidates for statin therapy under current guidelines. The JUPITER study population was defined on the basis of age, level of the biomarker C-reactive protein
Absolute risk reductions and consequent number-neededto-treat (NNT) values were calculated using data from JUPITER, a randomized trial of 20 mg of rosuvastatin versus placebo in 17, 802 men ≥ 50 years of age and women ≥ 60 years of age with C-reactive protein levels greater than 2 mg/L and LDL-C less than 130 mg/dL. Although the trial was stopped early after a mean of 1.9 years of follow-up, the NNT values at years 1, 2, 3, and 4 were calculated directly as the reciprocal of the absolute difference between risks of the outcome of interest at the specified time-point of interest. The 5-year NNT was estimated from the 4-year rate.
Results J. G. Robinson (*) Departments of Epidemiology & Medicine, University of Iowa, 200 Hawkins Drive SE 223 GH, Iowa City, IA 52242, USA e-mail: [email protected]
The 5-year NNT was 25 for JUPITER’s primary outcome of myocardial infarction (MI), stroke, hospitalization for unstable angina, arterial revascularization, or cardiovascular death, and the NNT was 29 for the secondary end point of
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MI, stroke, and death. All NNTs for the primary end point were less than 50. NNTs for the secondary end point were greater than 50 for women (52, vs 23 for men), Framingham risk score ≤ 10% (60, vs 20 if > 10%), and no traditional risk factors (54, vs 22 if ≥ 1 risk factor).
Discussion JUPITER participants had a median 10% 10-year coronary heart disease (CHD) risk by Framingham ris
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