JUPITER: a few words of caution.

Abstract

Since the JUPITER trial results were released in November 2008,1 they have been applauded by various sources (the media, the medical literature, cardiology experts, and health authorities) and described as a breakthrough, heralding large public health benefit and potentially dictating change in clinical practice toward the expansion of the use of statins for primary prevention. Such comments include the concept that statins should be given to everyone, regardless of their lipid levels.2,3 Based on the results of JUPITER, an additional 19% of the United States older population (men ≥50 years and women ≥60 years), or more than 11 million people, may become eligible for statin therapy, bringing the proportion of older adults with indications for statin therapy to ≈80%.4 JUPITER, an acronym for Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin, tested the hypothesis that statin treatment may reduce vascular events in persons with elevated high-sensitivity C-reactive protein (CRP) but without hyperlipidemia. The study enrolled apparently healthy people with LDL cholesterol levels of <130 mg/dL but with high-sensitivity CRP levels of ≥2.0 mg/L. Participants were randomly assigned to receive either rosuvastatin, 20 mg orally per day, or a placebo, and followed for cardiovascular events. The trial was planned to last 4 years, but it was stopped early for benefit by the data and safety monitoring board, after a median follow-up of 1.9 years. The reason for the enthusiasm and early termination of JUPITER was a hazard ratio of 0.56 (95% CI, 0.46 to 0.69), translating into a 44% relative risk reduction for the primary outcome favoring statin treatment, with similar reductions in other cardiovascular end points. But as Dr Hlatky cautioned, in his editorial to the JUPITER trial,5 what really matters for dictating changes in clinical practice is the absolute …