Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER)

Paul M Ridker; Jean G MacFadyen; Francisco A H Fonseca; Jacques Genest; Antonio M Gotto; John J P Kastelein; Wolfgang Koenig; Peter Libby; Alberto J Lorenzatti; Børge Nordestgaard; James Shepherd; James T Willerson; Robert J Glynn; JUPITER Study Group; Paul M Ridker; Jean G MacFadyen; Francisco A H Fonseca; Jacques Genest; Antonio M Gotto; John J P Kastelein; Wolfgang Koenig; Peter Libby; Alberto J Lorenzatti; Børge G Nordestgaard; James Shepherd; James T Willerson; Robert J Glynn; JUPITER Study Group

doi:10.1161/CIRCOUTCOMES.109.848473

Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER)

Paul M Ridker, Jean G MacFadyen, Francisco A H Fonseca, Jacques Genest, Antonio M Gotto, John J P Kastelein, Wolfgang Koenig, Peter Libby, Alberto J Lorenzatti, Børge Nordestgaard, James Shepherd, James T Willerson, Robert J Glynn, JUPITER Study Group, Paul M Ridker, Jean G MacFadyen, Francisco A H Fonseca, Jacques Genest, Antonio M Gotto, John J P KasteleinWolfgang Koenig, Peter Libby, Alberto J Lorenzatti, Børge G Nordestgaard, James Shepherd, James T Willerson, Robert J Glynn, JUPITER Study Group

108 Citations (Scopus)

Abstract

BACKGROUND: As recently demonstrated, random allocation to rosuvastatin results in large relative risk reductions for first cardiovascular events among apparently healthy men and women with low levels of low-density lipoprotein cholesterol but elevated levels of high-sensitivity C-reactive protein. However, whether the absolute risk reduction among such individuals justifies wide application of statin therapy in primary prevention is a controversial issue with broad policy and public health implications. METHODS AND RESULTS: Absolute risk reductions and consequent number needed to treat (NNT) values were calculated across a range of end points, timeframes, and subgroups using data from Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), a randomized evaluation of rosuvastatin 20 mg versus placebo conducted among 17 802 apparently healthy men and women with low-density lipoprotein cholesterol <130 mg/dL and high-sensitivity C-reactive protein >or=2 mg/L. Sensitivity analyses were also performed to address the potential impact that alternative statin regimens might have on a similar primary prevention population. For the end point of myocardial infarction, stroke, revascularization, or death, the 5-year NNT within JUPITER was 20 (95% CI, 14 to 34). All subgroups had 5-year NNT values for this end point below 50; as examples, 5-year NNT values were 17 for men and 31 for women, 21 for whites and 19 for nonwhites, 18 for those with body mass index 300). CONCLUSIONS: Absolute risk reductions and consequent NNT values associated with statin therapy among those with elevated high-sensitivity C-reactive protein and low low-density lipoprotein cholesterol are comparable if not superior to published NNT values for several widely accepted interventions for primary cardiovascular prevention, including the use of statin therapy among those with overt hyperlipidemia. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov. Identifier NCT00239681.

Original language	English
Journal	Circulation. Cardiovascular Quality and Outcomes
Volume	2
Issue number	6
Pages (from-to)	616-23
Number of pages	8
ISSN	1941-7713
DOIs	https://doi.org/10.1161/CIRCOUTCOMES.109.848473 https://doi.org/10.1161/CIRCOUTCOMES.109.848473
Publication status	Published - 1 Nov 2009

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Ridker, P. M., MacFadyen, J. G., Fonseca, F. A. H., Genest, J., Gotto, A. M., Kastelein, J. J. P., Koenig, W., Libby, P., Lorenzatti, A. J., Nordestgaard, B., Shepherd, J., Willerson, J. T., Glynn, R. J., JUPITER Study Group, Ridker, P. M., MacFadyen, J. G., Fonseca, F. A. H., Genest, J., Gotto, A. M., ... JUPITER Study Group (2009). Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER). Circulation. Cardiovascular Quality and Outcomes, 2(6), 616-23. https://doi.org/10.1161/CIRCOUTCOMES.109.848473, https://doi.org/10.1161/CIRCOUTCOMES.109.848473

Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER). / Ridker, Paul M; MacFadyen, Jean G; Fonseca, Francisco A H et al.

In: Circulation. Cardiovascular Quality and Outcomes, Vol. 2, No. 6, 01.11.2009, p. 616-23.

Research output: Contribution to journal › Journal article › Research › peer-review

Ridker, PM, MacFadyen, JG, Fonseca, FAH, Genest, J, Gotto, AM, Kastelein, JJP, Koenig, W, Libby, P, Lorenzatti, AJ, Nordestgaard, B, Shepherd, J, Willerson, JT, Glynn, RJ, JUPITER Study Group, Ridker, PM, MacFadyen, JG, Fonseca, FAH, Genest, J, Gotto, AM, Kastelein, JJP, Koenig, W, Libby, P, Lorenzatti, AJ, Nordestgaard, BG, Shepherd, J, Willerson, JT, Glynn, RJ & JUPITER Study Group 2009, 'Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER)', Circulation. Cardiovascular Quality and Outcomes, vol. 2, no. 6, pp. 616-23. https://doi.org/10.1161/CIRCOUTCOMES.109.848473, https://doi.org/10.1161/CIRCOUTCOMES.109.848473

Ridker PM, MacFadyen JG, Fonseca FAH, Genest J, Gotto AM, Kastelein JJP et al. Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER). Circulation. Cardiovascular Quality and Outcomes. 2009 Nov 1;2(6):616-23. doi: 10.1161/CIRCOUTCOMES.109.848473, http://dx.doi.org/10.1161/CIRCOUTCOMES.109.848473

Ridker, Paul M ; MacFadyen, Jean G ; Fonseca, Francisco A H et al. / Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER). In: Circulation. Cardiovascular Quality and Outcomes. 2009 ; Vol. 2, No. 6. pp. 616-23.

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title = "Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER)",

abstract = "BACKGROUND: As recently demonstrated, random allocation to rosuvastatin results in large relative risk reductions for first cardiovascular events among apparently healthy men and women with low levels of low-density lipoprotein cholesterol but elevated levels of high-sensitivity C-reactive protein. However, whether the absolute risk reduction among such individuals justifies wide application of statin therapy in primary prevention is a controversial issue with broad policy and public health implications. METHODS AND RESULTS: Absolute risk reductions and consequent number needed to treat (NNT) values were calculated across a range of end points, timeframes, and subgroups using data from Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), a randomized evaluation of rosuvastatin 20 mg versus placebo conducted among 17 802 apparently healthy men and women with low-density lipoprotein cholesterol <130 mg/dL and high-sensitivity C-reactive protein >or=2 mg/L. Sensitivity analyses were also performed to address the potential impact that alternative statin regimens might have on a similar primary prevention population. For the end point of myocardial infarction, stroke, revascularization, or death, the 5-year NNT within JUPITER was 20 (95% CI, 14 to 34). All subgroups had 5-year NNT values for this end point below 50; as examples, 5-year NNT values were 17 for men and 31 for women, 21 for whites and 19 for nonwhites, 18 for those with body mass index 300). CONCLUSIONS: Absolute risk reductions and consequent NNT values associated with statin therapy among those with elevated high-sensitivity C-reactive protein and low low-density lipoprotein cholesterol are comparable if not superior to published NNT values for several widely accepted interventions for primary cardiovascular prevention, including the use of statin therapy among those with overt hyperlipidemia. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov. Identifier NCT00239681.",

author = "Ridker, {Paul M} and MacFadyen, {Jean G} and Fonseca, {Francisco A H} and Jacques Genest and Gotto, {Antonio M} and Kastelein, {John J P} and Wolfgang Koenig and Peter Libby and Lorenzatti, {Alberto J} and B{\o}rge Nordestgaard and James Shepherd and Willerson, {James T} and Glynn, {Robert J} and {JUPITER Study Group} and Ridker, {Paul M} and MacFadyen, {Jean G} and Fonseca, {Francisco A H} and Jacques Genest and Gotto, {Antonio M} and Kastelein, {John J P} and Wolfgang Koenig and Peter Libby and Lorenzatti, {Alberto J} and Nordestgaard, {B{\o}rge G} and James Shepherd and Willerson, {James T} and Glynn, {Robert J} and B{\o}rge Nordestgaard",

note = "Keywords: Age Factors; Body Mass Index; C-Reactive Protein; Cholesterol, LDL; Continental Population Groups; Double-Blind Method; Endpoint Determination; Female; Fluorobenzenes; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Metabolic Syndrome X; Myocardial Infarction; Myocardial Revascularization; Primary Prevention; Pyrimidines; Risk Factors; Stroke; Sulfonamides",

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T1 - Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER)

AU - Ridker, Paul M

AU - MacFadyen, Jean G

AU - Fonseca, Francisco A H

AU - Genest, Jacques

AU - Gotto, Antonio M

AU - Kastelein, John J P

AU - Koenig, Wolfgang

AU - Libby, Peter

AU - Lorenzatti, Alberto J

AU - Nordestgaard, Børge

AU - Shepherd, James

AU - Willerson, James T

AU - Glynn, Robert J

AU - JUPITER Study Group

AU - Ridker, Paul M

AU - MacFadyen, Jean G

AU - Fonseca, Francisco A H

AU - Genest, Jacques

AU - Gotto, Antonio M

AU - Kastelein, John J P

AU - Koenig, Wolfgang

AU - Libby, Peter

AU - Lorenzatti, Alberto J

AU - Nordestgaard, Børge G

AU - Shepherd, James

AU - Willerson, James T

AU - Glynn, Robert J

AU - JUPITER Study Group

N1 - Keywords: Age Factors; Body Mass Index; C-Reactive Protein; Cholesterol, LDL; Continental Population Groups; Double-Blind Method; Endpoint Determination; Female; Fluorobenzenes; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Metabolic Syndrome X; Myocardial Infarction; Myocardial Revascularization; Primary Prevention; Pyrimidines; Risk Factors; Stroke; Sulfonamides

PY - 2009/11/1

Y1 - 2009/11/1

N2 - BACKGROUND: As recently demonstrated, random allocation to rosuvastatin results in large relative risk reductions for first cardiovascular events among apparently healthy men and women with low levels of low-density lipoprotein cholesterol but elevated levels of high-sensitivity C-reactive protein. However, whether the absolute risk reduction among such individuals justifies wide application of statin therapy in primary prevention is a controversial issue with broad policy and public health implications. METHODS AND RESULTS: Absolute risk reductions and consequent number needed to treat (NNT) values were calculated across a range of end points, timeframes, and subgroups using data from Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), a randomized evaluation of rosuvastatin 20 mg versus placebo conducted among 17 802 apparently healthy men and women with low-density lipoprotein cholesterol <130 mg/dL and high-sensitivity C-reactive protein >or=2 mg/L. Sensitivity analyses were also performed to address the potential impact that alternative statin regimens might have on a similar primary prevention population. For the end point of myocardial infarction, stroke, revascularization, or death, the 5-year NNT within JUPITER was 20 (95% CI, 14 to 34). All subgroups had 5-year NNT values for this end point below 50; as examples, 5-year NNT values were 17 for men and 31 for women, 21 for whites and 19 for nonwhites, 18 for those with body mass index 300). CONCLUSIONS: Absolute risk reductions and consequent NNT values associated with statin therapy among those with elevated high-sensitivity C-reactive protein and low low-density lipoprotein cholesterol are comparable if not superior to published NNT values for several widely accepted interventions for primary cardiovascular prevention, including the use of statin therapy among those with overt hyperlipidemia. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov. Identifier NCT00239681.

AB - BACKGROUND: As recently demonstrated, random allocation to rosuvastatin results in large relative risk reductions for first cardiovascular events among apparently healthy men and women with low levels of low-density lipoprotein cholesterol but elevated levels of high-sensitivity C-reactive protein. However, whether the absolute risk reduction among such individuals justifies wide application of statin therapy in primary prevention is a controversial issue with broad policy and public health implications. METHODS AND RESULTS: Absolute risk reductions and consequent number needed to treat (NNT) values were calculated across a range of end points, timeframes, and subgroups using data from Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), a randomized evaluation of rosuvastatin 20 mg versus placebo conducted among 17 802 apparently healthy men and women with low-density lipoprotein cholesterol <130 mg/dL and high-sensitivity C-reactive protein >or=2 mg/L. Sensitivity analyses were also performed to address the potential impact that alternative statin regimens might have on a similar primary prevention population. For the end point of myocardial infarction, stroke, revascularization, or death, the 5-year NNT within JUPITER was 20 (95% CI, 14 to 34). All subgroups had 5-year NNT values for this end point below 50; as examples, 5-year NNT values were 17 for men and 31 for women, 21 for whites and 19 for nonwhites, 18 for those with body mass index 300). CONCLUSIONS: Absolute risk reductions and consequent NNT values associated with statin therapy among those with elevated high-sensitivity C-reactive protein and low low-density lipoprotein cholesterol are comparable if not superior to published NNT values for several widely accepted interventions for primary cardiovascular prevention, including the use of statin therapy among those with overt hyperlipidemia. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov. Identifier NCT00239681.

U2 - 10.1161/CIRCOUTCOMES.109.848473

DO - 10.1161/CIRCOUTCOMES.109.848473

M3 - Journal article

C2 - 20031900

SN - 1941-7713

VL - 2

SP - 616

EP - 623

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

IS - 6

ER -