The Numbers Are In

Abstract

In this issue of Circulation , Mora et al demonstrate for the first time that statins are effective for the primary prevention of cardiovascular events in women.1 Under a prespecified analysis, the authors examined sex-specific outcomes in JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), which enrolled 6801 women ≥60 years old and 11 001 men ≥50 years old without prior history of coronary heart disease, diabetes mellitus, or stroke who had low-density lipoprotein cholesterol (LDL-C) <130 mg/dL and high-sensitivity C-reactive protein (hsCRP) ≥2.0 mg/L.2 Article see p 1069 Patients were randomized to receive rosuvastatin 20 mg daily versus placebo and were followed up for a median of only 2 years—a remarkably short period—because the trial was terminated early owing to the identification of significant benefit with treatment in the overall study population. The results from the subgroup analysis in the article by Mora et al indicate a statistically significant relative risk reduction in women for the primary end point of myocardial infarction, stroke, hospitalization for unstable angina, arterial revascularization, or cardiovascular death, which was similar to the reduction seen in men (hazard ratio 0.54, P =0.002 versus 0.58, P <0.001, respectively). To put their findings in appropriate context, the authors also included in their article a meta-analysis of 5 exclusively or predominately primary prevention trials of statins that reported sex-specific outcomes.2–7 The total number of women in the 3 exclusively primary prevention trials (JUPITER, Primary Prevention of Acute Coronary Events With Lovastatin in Men and Women With Average Cholesterol Levels: Results of Air Force/Texas Coronary Atherosclerosis Prevention Study [AFCAPS/TexCAPS], and Usefulness of Pravastatin in Primary Prevention of Cardiovascular Events in Women: Analysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese [MEGA]) was 13 154, …