Level 1: Likely reliable evidence

The Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) studied the use of rosuvastatin (Crestor) for prevention of cardiovascular events in patients with normal cholesterol levels but elevated C reactive protein (CRP) levels (N Engl J Med. 2008;359:2195-2207). A total of 17,802 patients (11,001 men aged 50 and older and 6,801 women aged 60 and older) without cardiovascular disease at baseline were randomized to either rosuvastatin 20 mg daily or placebo and followed for median 1.9 years. All patients had elevated CRP (>2 mg/L) and LDL <130 mg/dL (3.4 mmol/L). The primary end point, a composite of MI, stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death, was significantly lower for patients taking rosuvastatin compared with those taking placebo (1.6% vs. 2.8%, P <.00001, NNT 84). These results correspond to an estimated NNT of 25 over five years of treatment. The primary end point was also significantly lower for rosuvastatin in subgroup analyses of men only, women only, patients 65 years old and younger, and patients older than 65 years. Compared with placebo, rosuvastatin also reduced all-cause mortality (NNT 182), incidence of MI (NNT 244) and stroke (NNT 286), and rate of arterial revascularization (NNT 150). Incidence of diabetes was significantly higher in the rosuvastatin group (3% vs. 2.4%, P = .01, NNH 167).