Written by Babatunde Carew
Spoon Feed
Rosuvastatin significantly reduced cardiovascular events in patients with normal LDL but elevated hs-CRP, highlighting the role of inflammation in CV risk.
Statins vs. inflammation – a heartfelt victory?
Cardiovascular (CV) disease is the leading cause of death worldwide, responsible for about 13% of the world’s total deaths, and incidence is rising. The JUPITER trial addressed whether rosuvastatin reduced major cardiovascular events in individuals with normal LDL cholesterol but elevated high-sensitivity C-reactive protein. This randomized, placebo-controlled trial included 17,802 participants with a median follow up of 1.9 years. Rosuvastatin significantly lowered LDL cholesterol by 50% and reduced cardiovascular event rates by 44% (HR 0.56, 95% CI 0.46–0.69, p<0.00001).
As we now know that lower LDL is better in CV risk reduction, it would be interesting to see the impact of rosuvastatin use in a population with similar LDL levels and health status without hs-CRP elevation. Notably, the study was funded by Astra-Zeneca, the manufacturer of rosuvastatin.
How does this change my practice?
Published in 2008, this study demonstrated that there is likely more to CV risk than LDL alone. In recent years, colchicine and other anti-inflammatories have been shown to improve CV risk, further supporting that inflammation plays a role in the disease process. In my current practice, I use coronary calcium scoring to make a statin decision in patients with low or borderline LDL levels/ASCVD risk score but co-existing risk factors. This study highlights hs-CRP as an option to further risk-stratify patients; however, further studies are needed to explore how it should be used along side structural imaging, lipoprotein measurement, and other emerging risk-stratification tools to make meaningful changes to treatment.
Source
Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008 Nov 20;359(21):2195-207. doi: 10.1056/NEJMoa0807646. Epub 2008 Nov 9. PMID: 18997196
