23 juin 2016
JUPITER? : Justification for the Use of Statins in Primary Prevention : An Intervention Trial Evaluating Rosuvastatin.
Statin therapy in women without cardiovascular disease (CVD) is controversial, given the insufficient evidence of benefit. We analyzed sex-specific outcomes in the Justification for the Use of Statins in Prevention : An Intervention Trial Evaluating Rosuvastatin (JUPITER) and synthesized the results with prior trials.
METHODS AND RESULTS :
JUPITER participants included 6801 women > or =60 years of age and 11 001 men > or =50 years of age with high-sensitivity C-reactive protein > or =2 mg/L and low-density lipoprotein cholesterol <130 mg/dL randomized to rosuvastatin versus placebo. Meta-analysis studies were randomized placebo-controlled statin trials with predominantly or exclusively primary prevention in women and sex-specific outcomes (20 147 women ; >276 CVD events ; mean age, 63 to 69 years). Absolute CVD rates (per 100 person-years) in JUPITER women for rosuvastatin and placebo (0.57 and 1.04, respectively) were lower than for men (0.88 and 1.54, respectively), with similar relative risk reduction in women (hazard ratio, 0.54 ; 95% confidence interval, 0.37 to 0.80 ; P=0.002) and men (hazard ratio, 0.58 ; 95% confidence interval, 0.45 to 0.73 ; P<0.001). In women, there was significant reduction in revascularization/unstable angina and nonsignificant reductions in other components of the primary end point. Meta-analysis of 13 154 women (240 CVD events ; 216 total deaths) from exclusively primary prevention trials found a significant reduction in primary CVD events with statins by a third (relative risk, 0.63 ; 95% confidence interval, 0.49 to 0.82 ; P<0.001 ; P for heterogeneity=0.56) with a smaller nonsignificant effect on total mortality (relative risk, 0.78 ; 95% confidence interval, 0.53 to 1.15 ; P=0.21 ; P for heterogeneity=0.20). Similar results were obtained for trials that were predominantly but not exclusively primary prevention.
JUPITER demonstrated that in primary prevention rosuvastatin reduced CVD events in women with a relative risk reduction similar to that in men, a finding supported by meta-analysis of primary prevention statin trials.
Mora S, Glynn RJ, Hsia J, MacFadyen JG, Genest J, Ridker PM. Statins for the primary prevention of cardiovascular events in women with elevated high-sensitivity C-reactive protein or dyslipidemia : results from the Justification for the Use of Statins in Prevention : An Intervention Trial Evaluating Rosuvastatin (JUPITER) and meta-analysis of women from primary prevention trials.Circulation.2010 Mar 9 ;121(9):1069-77. 20176986
Ridker PM, MacFadyen J, Cressman M, Glynn RJ. Efficacy of rosuvastatin among men and women with moderate chronic kidney disease and elevated high-sensitivity C-reactive protein : a secondary analysis from the JUPITER (Justification for the Use of Statins in Prevention-an Intervention Trial Evaluating Rosuvastatin) trial.J Am Coll Cardiol.2010 Mar 23 ;55(12):1266-73. 20206456