Predicting benefit from statins by C-reactive protein, LDL-cholesterol or absolute cardiovascular risk.

Evaluation of: Ridker PM, Danielson E, Fonseca FA et al.: Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N. Engl. J. Med. 359, 2195-2207 (2008). The Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) randomized nearly 18,000 subjects with no history of cardiovascular disease and an average or low LDLcholesterol level (<3.4 mmol/l), but a high plasma level of C-reactive protein (CRP; >2 mg/dl), to rosuvastatin 20 mg or placebo daily. The trial was stopped early because of a highly statistically significant 46% reduction in cardiovascular events for patients randomized to rosuvastatin. Participants who achieved an LDL-cholesterol level lower than 1.8 mmol/l and a CRP level lower than 2 mg/dl on treatment had the greatest decrease in cardiovascular risk. The JUPITER trial provides evidence that the benefits of statins relate in part to decreased inflammation. Comparison with other statin trials indicates that absolute cardiovascular risk is an important predictor of benefit from statin treatment, and potent statins that result in a greater percentage reduction in LDLcholesterol and CRP are likely to reduce risk more. Targeting statin treatment based on LDL-cholesterol alone will not provide an optimal risk reduction for many individuals.