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• W2022049609 abstract "Although I laud Paul Ridker and colleagues1Ridker PM Danielson E Fonseca F et al.Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial.Lancet. 2009; 373: 1175-1183Summary Full Text Full Text PDF PubMed Scopus (807) Google Scholar for demonstrating the vascular anti-inflammatory benefits of rosuvastatin, we should consider the less expensive anti-inflammatory option: aspirin. Aspirin was used by only 16·6% of participants in the placebo and rosuvastatin groups, despite their elevated cardiovascular risk and thus indication for aspirin2Hayden M Pignone M Phillips C Mulrow C Aspirin for the primary prevention of cardiovascular events: a summary of the evidence for the US Preventive Services Task Force.Ann Intern Med. 2002; 136: 161-172Crossref PubMed Scopus (562) Google Scholar (42·1% in the placebo group and 38·3% in the rosuvastatin group had metabolic syndrome). Why aspirin use was not enforced is unclear, since its use is indicated (in the absence of specific contraindications) by age, diabetes, and hypertension individually, let alone when in combination. Ironically, a previous article by Ridker3Ridker PM Cushman M Stampfer MJ Tracy RP Hennekens CH Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men.N Engl J Med. 1997; 336: 973-979Crossref PubMed Scopus (4820) Google Scholar supports aspirin use to lessen myocardial infarction risk through reduction of high-sensitivity C-reactive protein (hsCRP). Meanwhile we must consider that if we do treat patients on the basis of their hsCRP concentration, most western populations would require statins (which might be excessive without more long-term data). A perhaps more subtle point that readers should consider is that statins are not only anti-inflammatory and cholesterol-lowering, but also partly antithrombotic themselves4Rosenson RS Tangney CC Antiatherothrombotic properties of statins: implications for cardiovascular event reduction.JAMA. 1998; 279: 1643-1650Crossref PubMed Scopus (973) Google Scholar and able to reduce venous thromboembolism.5Glynn RJ Danielson E Fonseca FA Genest J Gotto AM A randomized trial of rosuvastatin in the prevention of venous thromboembolism.N Engl J Med. 2009; 360: 1851-1861Crossref PubMed Scopus (587) Google Scholar If the benefits of rosuvastatin in the JUPITER study are corroborated by another similar study in which aspirin is adequately used, then we should consider broadening statin therapy. I declare that I have no conflicts of interest. Rosuvastatin, C-reactive protein, LDL cholesterol, and the JUPITER trial – Authors' replyWe agree with Jaime García de Tena that smoking cessation, blood pressure control, and lifestyle modification remain important for primary prevention. However, half of all vascular events occur among those with average or low concentrations of cholesterol. JUPITER showed that targeting statin therapy to those with elevated high-sensitivity C-reactive protein (hsCRP) and low LDL cholesterol reduces heart attack and stroke by 50% and total mortality by 20%. Similar benefits were seen among those with elevated hsCRP and no other major risk factors. Full-Text PDF" @default.
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• W2022049609 date "2009-07-01" @default.
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• W2022049609 title "Rosuvastatin, C-reactive protein, LDL cholesterol, and the JUPITER trial" @default.
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