6.5 Million Additional Adults Candidates for Statin Therapy Based on JUPITER

Counselor,

More than six million elderly adults are newly eligible for statin therapy based on a strict interpretation of the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial, new research show. The number of individuals eligible for statin therapy increases to more than 10 million adults when extrapolated to individuals with normal LDL-cholesterol levels, as determined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP) cutoff points, and elevated high-sensitivity (hs) C-reactive-protein (CRP) levels.

"JUPITER was so big because it is the first trial to show that statin therapy reduces cardiovascular events in a primary-prevention setting in people who have low to normal LDL cholesterol but are at an increased risk based on an elevated marker of inflammation," lead investigator Dr Erin Donnelly Michos (Johns Hopkins University School of Medicine, Baltimore, MD) told heartwire. "When JUPITER came out, we wanted to know just how many people fit into this category."

Publishing their results in the March 17, 2009 issue of the Journal of the American College of Cardiology, Michos said that based on JUPITER's number needed to treat (NNT) to prevent one cardiovascular event, the NNT being 25 at five years, roughly 260 000 events could be prevented following this treatment strategy.

This is the second study published in the past two months assessing the impact of the landmark JUPITER study. An earlier report suggested that nearly eight million US adults would be eligible for statin therapy based on JUPITER and that an additional three million had an extended JUPITER indication. 

Asked how JUPITER has changed practice, Michos said she uses CRP levels as a "tie-breaker" for deciding how aggressive to be in primary prevention, particularly in older patients who do not meet the current criteria for statin therapy but who do have some cardiovascular risk factors.

A similar study by Dr Erica Spatz (Yale University School of Medicine, New Haven, CT), reported by heartwire when it was published in January, suggested that nearly eight million US adults would be eligible for statin therapy based on JUPITER and that an additional three million had an extended JUPITER indication.

Michos explained, however, that these numbers are higher because she and Blumenthal strictly excluded patients based on JUPITER's protocol. She noted that the analysis by Spatz and colleagues included patients on hormone-replacement therapy (HRT), whereas her analysis did not.

"If anything, then, our numbers are conservative," said Michos. "Estrogen use has fallen off a lot since 2002, and our NHANES data took into account 1999 to 2004, so if we had today's numbers our estimates might even be higher. I think the studies reaffirm each other. Ours is a more conservative number, and theirs [Spatz et al] is probably a more real-world estimate."

Read entire article here.

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