From Here to JUPITER

Abstract

Background— Guidelines for statin use currently focus on patients with elevated low-density lipoprotein levels. Recent findings from the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER), however, indicate that statin therapy to reduce cardiovascular risk is also effective among older persons with at-goal low-density lipoprotein but elevated high-sensitivity C-reactive protein levels. We estimate the size of and describe this new population for whom statin therapy may now be indicated based on JUPITER’s findings. Methods and Results— Using data from the 1999 to 2004 National Health and Nutrition Examination Survey, we estimate that 57.9% of older adults (men ≥50 years and women ≥60 years), or 33 547 000 (95% CI, 32 217 000 to 34 877 000) Americans, are currently taking a statin (24.4%) or indicated for statin therapy (33.5%). In addition, we estimate that 19.2%, or 11 144 000 (95% CI, 10 053 000 to 12 235 000), may become newly eligible for statin therapy. This includes 8 071 000 (13.9%; 95% CI, 7 173 000 to 8 969 000) with high-sensitivity C-reactive protein ≥2 mg/L and low-density lipoprotein <130 mg/dL (ie, those meeting “strict” JUPITER criteria) and an additional 3 073 000 (5.3%; 95% CI, 2 404 000 to 3 743 000) with high-sensitivity C-reactive protein ≥2 mg/L and low-density lipoprotein of 130 to 160 mg/dL for whom JUPITER’s findings might reasonably be extended. Thus, ≈80% of older persons may now have an indication for statin therapy. Compared with those who would continue to have no indication for statin therapy, the JUPITER group was more likely to be female, to be older, and to have obesity, hypertension, and the metabolic syndrome. Conclusions— JUPITER’s findings have the potential to impact treatment recommendations for ≈20% of middle-aged to elderly adults, thus increasing the proportion of this segment of the population with an indication for statin therapy to nearly 80%.

How Do We Improve Patient Compliance and Adherence to Long-Term Statin Therapy?

“…increased CRP; Apo B and LDL particle number (LDL-P),which are potential markers particularly for subsets of patients with cholesterol-poor LDL) [12, 21, 22], branded statins going generic, as well as recommendation of earlier age of lipid screening and treatment [23]. Statins have now become standard of care, so much so that clinical trials of new lipid lowering therapies are being done on top of statins rather than as stand-alone drugs [24-27].…”

Prospective analysis of association between use of statins and melanoma risk in the Women's Health Initiative

“…19 Preclinical studies in a mouse melanoma cell line have demonstrated inhibition of cell migration, invasion, adhesion, and metastasis. 20 With an estimated 45 million Americans using statins for their cardioprotective effects, 21 statins may provide an easy way in which to reduce the burden of melanoma.…”

Within-Person Variability in High-Sensitivity C-Reactive Protein

“…1–3 Based on findings from recent clinical trials, CRP has been recommended as an adjunct screening tool to stratify cardiovascular risk in the general population 4 . However, evidence regarding within-person variability of CRP in the general population is limited.…”