Cardiovascular Event Reduction and Adverse Events Among Subjects Attaining Low-Density Lipoprotein Cholesterol <50 mg/dl With Rosuvastatin

Hsia, Judith; MacFadyen, Jean G.; Monyak, John; Ridker, Paul M.

doi:10.1016/j.jacc.2010.09.082

Cited by 231Lipoproteins and Cardiovascular HealthCancer, Lipids, and MetabolismAcute Myocardial Infarction Research

Cardiovascular Event Reduction and Adverse Events Among Subjects Attaining Low-Density Lipoprotein Cholesterol <50 mg/dl With Rosuvastatin

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Hsia, Judith, MacFadyen, Jean G., Monyak, John, Ridker, Paul M.·2011·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2010.09.082

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Abstract

Objectives The purpose of this study was to assess the impact on cardiovascular and adverse events of attaining low-density lipoprotein cholesterol (LDL-C) levels <50 mg/dl with rosuvastatin in apparently healthy adults in the JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial.Background The safety and magnitude of cardiovascular risk reduction conferred by treatment to LDL-C levels below current recommended targets remain uncertain.Methods A cohort of 17,802 apparently healthy men and women with high-sensitivity C-reactive protein ≥2 mg/l and LDL-C <130 mg/dl were randomly allocated to rosuvastatin 20 mg daily or placebo, and followed up for all-cause mortality, major cardiovascular events, and adverse events. In a post-hoc analysis, participants allocated to rosuvastatin were categorized as to whether or not they had a follow-up LDL-C level <50 mg/dl.Results During a median follow-up of 2 years (range up to 5 years), rates of the primary trial endpoint were 1.18, 0.86, and 0.44 per 100 person-years in the placebo group (n = 8,150) and rosuvastatin groups without LDL-C <50 mg/dl (n = 4,000) or with LDL-C <50 mg/dl (n = 4,154), respectively (fully-adjusted hazard ratio: 0.76; 95% confidence interval: 0.57 to 1.00 for subjects with no LDL-C <50 mg/dl vs. placebo and 0.35, 95% confidence interval: 0.25 to 0.49 for subjects attaining LDL-C <50 mg/dl; p for trend <0.0001). For all-cause mortality, corresponding event rates were 0.67, 0.65, and 0.39 (p for trend = 0.004). Rates of myalgia, muscle weakness, neuropsychiatric conditions, cancer, and diabetes mellitus were not significantly different among rosuvastatin-allocated participants with and without LDL-C <50 mg/dl.Conclusions Among adults with LDL-C <130 mg/dl and high-sensitivity C-reactive protein ≥2 mg/l, rosuvastatin-allocated participants attaining LDL-C <50 mg/dl had a lower risk of cardiovascular events without a systematic increase in reported adverse events.

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The greater the absolute LDL-C reduction, the greater the reduction in cardiovascular risk.
“the greater the absolute LDL-C reduction, the greater the CV risk reduction [35,36,50,115].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [115]
Evidence suggests that lowering LDL-C beyond the goals set in previous EAS/ESC guidelines is associated with fewer cardiovascular disease events.
“There is also evidence suggesting that lowering LDL-C beyond the goals that were set in the previous EAS/ESC guidelines is associated with fewer CVD events. 126”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [126]
Lowering LDL-C beyond previous EAS/ESC goals is associated with fewer cardiovascular disease events.
“There is also evidence suggesting that lowering LDL-C beyond the goals that were set in the previous EAS/ESC guidelines is associated with fewer CVD events.126”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [126]

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LaRosa JC, Grundy SM, Kastelein JJP, et al. Safety and efficacy of atorvastatin-induced very low-density lipoprotein cholesterol levels in patients with coronary heart disease (a post hoc analysis of the Treating to New Targets [TNT] study). Am J Cardiol 2007;100:747-52.

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LDL Cholesterol: The Lower the Better
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Curing atherosclerosis should be the next major cardiovascular prevention goal
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Non-antibody Approaches to Proprotein Convertase Subtilisin Kexin 9 Inhibition: siRNA, Antisense Oligonucleotides, Adnectins, Vaccination, and New Attempts at Small-Molecule Inhibitors Based on New Discoveries
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Inflammation and thrombosis – testing the hypothesis with anti- inflammatory drug trials
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Repurposing of Existing Statin Drugs for Treatment of Microbial Infections: How Much Promising?
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Beyond Cholesterol: Emerging Risk Factors in Atherosclerosis
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Efficacy and safety of PCSK9 monoclonal antibodies
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Colesterol LDL, cuanto más bajo mejor
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Statin‐associated muscle symptoms: A comprehensive exploration of epidemiology, pathophysiology, diagnosis, and clinical management strategies
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Incidence of Musculoskeletal and Neoplastic Diseases in Patients on Statin Therapy: Results of a Retrospective Cohort Analysis
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Statin use and non-melanoma skin cancer risk: a meta-analysis of randomized controlled trials and observational studies
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Statins, mood, sleep, and physical function: a systematic review
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Fixed-dose combination of rosuvastatin and ezetimibe: treating hypercholesteremia according to cardiovascular risk
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Lipids, Apolipoproteins, and Inflammatory Biomarkers of Cardiovascular Risk: What Have We Learned?
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Advances in the treatment of dyslipidemia
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Cardiovascular Event Reduction and Adverse Events Among Subjects Attaining Low-Density Lipoprotein Cholesterol <50mg/dl With Rosuvastatin: The JUPITER Trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin)
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Study Group Summary
(2009)
JUPITER and ACCOMPLISH
Liebson, P. R. (2009) · Preventive Cardiology · doi:10.1111/j.1751-7141.2009.00032.x

Authors: Hsia, J., MacFadyen, J. G., Monyak, J., & Ridker, P. M.
Affiliations: AstraZeneca (United States) (US)
Brigham and Women's Hospital (US)
Corresponding author: Hsia, Judith
ORCID: Hsia, Judith
Monyak, John
Ridker, Paul M.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2011-04
Volume: 57
Issue: 16
Pages: 1666-1675
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2010.09.082
OpenAlex: W166112863
Cited by: 231
References: 41
Citations by year: 2026: 3 · 2025: 7 · 2024: 7 · 2023: 8 · 2022: 12 · 2021: 8 · 2020: 10 · 2019: 15 · 2018: 14 · 2017: 23 · 2016: 23 · 2015: 30 · 2014: 20 · 2013: 22 · 2012: 19
FWCI: 23.22
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 837 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Funders: AstraZeneca LP
AstraZeneca
Novartis
Merck
Abbott
Roche
Sanofi-Aventis
Topics: Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords: rosuvastatin, LDL cholesterol, cardiovascular risk reduction, high-sensitivity C-reactive protein, JUPITER trial, statin safety, all-cause mortality, major adverse cardiovascular events, myalgia, diabetes mellitus, cancer, neuropsychiatric adverse effects, hypercholesterolemia, inflammation, cardiovascular disease prevention
MeSH terms: Rosuvastatin Calcium, Aged, Cardiovascular Diseases, Female, Fluorobenzenes, Follow-Up Studies, Humans, Cholesterol, LDL, Male, Middle Aged, Pyrimidines, Sulfonamides, Cohort Studies, Biomarkers, Hydroxymethylglutaryl-CoA Reductase Inhibitors

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Cardiovascular Event Reduction and Adverse Events Among Subjects Attaining Low-Density Lipoprotein Cholesterol <50 mg/dl With Rosuvastatin

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