Rosuvastatin Dramatically Reduces Common Stroke For Healthy Adults
In the landmark JUPITER trial of 17,802 patients, researchers from Brigham and Women’s Hospital (BWH) report that rosuvastatin reduces by nearly 50 percent the risk of stroke among individuals who had low levels of cholesterol but were nonetheless at high risk for stroke due to increased levels of a simple blood test for the inflammatory biomarker hsCRP (high sensitivity C-reactive protein). These findings are presented at the 2009 Scientific Sessions of the American Stroke Association in San Diego.
The JUPITER trial focused on low cholesterol/high hsCRP patients who were given a daily regimen of rosuvastatin. Compared to study participants who were given a placebo the researchers found a 48 percent reduction in stroke. During a follow-up period of up to 5 years, there were 33 stroke events among those randomly given 20mg of rosuvastatin daily, compared to 64 strokes among those given a placebo This reduction in risk was almost entirely due to strokes caused by blood clots or reduced blood flow to the brain. No increase or decrease in risk of rare hemorrhagic strokes due to bleeding were observed during the trial.
“The JUPITER data clearly demonstrate that statin therapy reduces stroke risk among individuals with elevated levels of hsCRP” said Dr. Robert Glynn from the Division of Preventive Medicine at Brigham and Women’s Hospital who presented the data. “Prior prevention studies that relied on cholesterol to identify high risk patients have not found similar benefits. These findings also underscore the important role that inflammation plays in stroke.”
“Our results are relevant for patient care and the prevention of stroke,” said Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital and Principal Investigator of the JUPITER trial. “Physicians can no longer assume that patients are at low risk for stroke simply because they have low cholesterol. We have confirmed that patients with increased hsCRP are at increased stroke risk even if cholesterol levels are low, and we now have evidence that a simple and safe therapy cuts that risk and saves lives.”
Started in 2003, JUPITER (the Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) was designed to test whether rosuvastatin, taken at 20mg daily compared to placebo, could reduce the risk of cardiovascular events among apparently healthy men and women who had LDL cholesterol levels below 130mg/dL who were nonetheless at silent risk due to increased levels of inflammation as measured by a simple blood test known as high sensitivity C-reactive protein (hsCRP).
Prior work had established that patients with increased hsCRP were at high risk for heart disease and stroke despite lacking other conventional risk factors, and that statins lower hsCRP levels, indicating anti-inflammatory as well as cholesterol lowering effects. Until JUPITER, whether or not statin treatment would be effective in reducing cardiac events among these patients had been uncertain.
Participants in JUPITER had cholesterol levels widely considered optimal by most physicians; the average LDL cholesterol was just above 100mg/dL and the average HDL cholesterol was nearly 50mg/dL. Nonetheless, event rates in the trial were high because all participants had elevated levels of hsCRP.
“JUPITER should change prevention guidelines” said Dr. James Willerson, Director of the Texas Heart Institute in Houston. “The bottom line here is simple – if your hsCRP is high, you should be on statin therapy regardless of your cholesterol level. This is an approach we can start using tomorrow”.