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American Heart Association 2008 Wrap-Up Report: Top Research Advances Include Studies That Influence Medical Care, Apply Science To 'Real World' Communities
Date:1/21/2009

lar events in men and women with elevated C-reactive protein

Substantial evidence demonstrates the effectiveness of lowering LDL cholesterol to prevent repeat cardiovascular events, so-called secondary prevention. While lifestyle modification is important, and several types of medications can be used to lower the LDL, most patients are prescribed statins, (HMG CoA reductase inhibitors). For primary prevention to reduce the risk of an individual's first event, the decision about whether to add medications to a healthy lifestyle is based on the patient's overall risk of an event, assessed by a measure such as the Framingham risk score. In the JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial, individuals (median age 66) were recruited if they had no known coronary disease and had LDL levels below 130, which usually would not mandate treatment with a statin. Some had Framingham scores indicating moderate risk, but a substantial number did not. All, however, were included in the study because of elevated hs-CRP levels, a marker of inflammation, a process that has been speculated to be another cause of atherosclerosis. Treatment with rosuvastatin in both groups resulted in nearly halving LDL cholesterol and hs-CRP levels and produced a significant relative reduction in nonfatal heart attack (55 percent), nonfatal stroke (48 percent) and the composite endpoint including CV death (47 percent). This large (17,802 patients) study and its many subgroups have generated extensive discussion about its implications for expanding indications for the use of statins, and the findings will be considered as primary prevention guidelines are revised in 2009.

Source: New England Journal of Medicine, November 20, 2008; N Engl J Med 2008;359:2195-207. www.nejm.org; also presented at the Americ
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