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Cardiovascular Event Reduction and Adverse Events Among Subjects Attaining Low-Density Lipoprotein Cholesterol <50 mg/dl With Rosuvastatin
Open accessAbstract
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 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]
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“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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“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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Metadata
- 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
- 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)
- 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
- 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 › Cardiology and Cardiovascular Medicine › 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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