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JUPITER Trial Shows Way to Reduce Heart Attack, Stroke
BWH researchers have found a way to cut in half the risk of heart attack and stroke among patients with low cholesterol and high levels of inflammation.
In the landmark JUPITER trial of 17, 802 patients, researchers found that the medication rosuvastatin reduced by 50 percent the risk of heart attack, stroke and cardiovascular death among men and women who had low levels of cholesterol but were still at high risk for vascular disease, due to increased levels of inflammation, or high sensitivity C-reactive protein (hsCRP).
“Physicians no longer can assume that patients are at low risk for heart disease simply because they have low cholesterol,” said Paul Ridker, MD, director of the BWH Center for Cardiovascular Disease Prevention and lead author of this study. “We have confirmed that patients with increased high-sensitivity C-reactive protein are at high risk.”
Half of all heart attacks occur in people with normal or low cholesterol. Testing patients for hsCRP, a marker of inflammation, with a blood test is one way to determine their risk of heart attack.
“For the cardiology world, discovering a major new risk factor as well as an effective treatment is like hitting a walk-off home run to win the World Series,” said Eugene Braunwald, MD, chairman of BWH’s TIMI Study Group.
The study findings, which were published in the New England Journal of Medicine, were publicly released at the 2008 Scientific Sessions of the American Heart Association earlier this week and attracted attention from media outlets around the world.
The JUPITER trial began in 2003 to test whether rosuvastatin could reduce the risk of cardiovascular events in apparently healthy men and women. Prior work at BWH had established that those with increased hsCRP were at high risk for heart disease, despite lacking other conventional risk factors, and that statins lower hsCRP levels. That indicates that statins have anti-inflammatory as well as cholesterol-lowering effects. Until the trial concluded, there was no proof that statin treatment would be effective in reducing cardiac events among these patients.
The findings likely will change the way that care is delivered to these patients.
“We believe that the JUPITER data are compelling and have major public health implications that merit careful consideration by guidelines committees,” said Peter Libby, MD, chief of Cardiovascular Medicine. “The concept that inflammatory status can improve our ability to target therapy represents a clinically important translation of the science of inflammation in cardiovascular disease, a longtime focus of our vascular research laboratories at the Brigham.”