Number Needed to Treat With Rosuvastatin to Prevent First Cardiovascular Events and Death Among Men and Women With Low Low-Density Lipoprotein Cholesterol and Elevated High-Sensitivity C-Reactive Protein Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)

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dc.contributor.authorRidker, Paul M.
dc.contributor.authorMacFadyen, Jean G.
dc.contributor.authorFonseca, Francisco Antonio Helfenstein [UNIFESP]
dc.contributor.authorGenest, Jacques
dc.contributor.authorGotto, Antonio M.
dc.contributor.authorKastelein, John J. P.
dc.contributor.authorKoenig, Wolfgang
dc.contributor.authorLibby, Peter
dc.contributor.authorLorenzatti, Alberto J.
dc.contributor.authorNordestgaard, Borge G.
dc.contributor.authorShepherd, James
dc.contributor.authorWillerson, James T.
dc.contributor.authorGlynn, Robert J.
dc.contributor.authorJUPITER Study Grp
dc.contributor.institutionHarvard Univ
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionMcGill Univ
dc.contributor.institutionCornell Univ
dc.contributor.institutionUniv Amsterdam
dc.contributor.institutionUniv Ulm
dc.contributor.institutionHosp Cordoba
dc.contributor.institutionUniv Copenhagen
dc.contributor.institutionUniv Glasgow
dc.contributor.institutionSt Lukes Episcopal Hosp
dc.date.accessioned2016-01-24T13:58:51Z
dc.date.available2016-01-24T13:58:51Z
dc.date.issued2009-11-01
dc.description.abstractBackground-As recently demonstrated, random allocation to rosuvastatin results in large relative risk reductions for first cardiovascular events among apparently healthy men and women with low levels of low-density lipoprotein cholesterol but elevated levels of high-sensitivity C-reactive protein. However, whether the absolute risk reduction among such individuals justifies wide application of statin therapy in primary prevention is a controversial issue with broad policy and public health implications.Methods and Results-Absolute risk reductions and consequent number needed to treat (NNT) values were calculated across a range of end points, timeframes, and subgroups using data from Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), a randomized evaluation of rosuvastatin 20 mg versus placebo conducted among 17 802 apparently healthy men and women with low-density lipoprotein cholesterol <130 mg/dL and high-sensitivity C-reactive protein >= 2 mg/L. Sensitivity analyses were also performed to address the potential impact that alternative statin regimens might have on a similar primary prevention population. for the end point of myocardial infarction, stroke, revascularization, or death, the 5-year NNT within JUPITER was 20 (95% CI, 14 to 34). All subgroups had 5-year NNT values for this end point below 50; as examples, 5-year NNT values were 17 for men and 31 for women, 21 for whites and 19 for nonwhites, 18 for those with body mass index <= 5 kg/m(2) and 21 for those with body mass index greater than 25 kg/m2, 9 and 26 for those with and without a family history of coronary disease, 19 and 22 for those with and without metabolic syndrome, and 14 and 37 for those with estimated Framingham risks greater or less than 10%. for the net vascular benefit end point that additionally included venous thromboembolism, the 5-year NNT was 18 (95% CI, 13 to 29). for the restricted hard end point of myocardial infarction, stroke, or death, the 5-year NNT was 29 (95% CI, 19 to 56). in sensitivity analyses addressing the theoretical utility of alternative agents, 5-year NNT values of 38 and 57 were estimated for statin regimens that deliver 75% and 50% of the relative benefit observed in JUPITER, respectively. All of these calculations compare favorably to 5-year NNT values previously reported in primary prevention for the use of statins among hyperlipidemic men (5-year NNT, 40 to 70), for antihypertensive therapy (5-year NNT, 80 to 160), or for aspirin (5-year NNT, >300).Conclusions-Absolute risk reductions and consequent NNT values associated with statin therapy among those with elevated high-sensitivity C-reactive protein and low low-density lipoprotein cholesterol are comparable if not superior to published NNT values for several widely accepted interventions for primary cardiovascular prevention, including the use of statin therapy among those with overt hyperlipidemia.en
dc.description.affiliationHarvard Univ, Ctr Cardiovasc Dis Prevent, Brigham & Womens Hosp, Sch Med, Boston, MA 02215 USA
dc.description.affiliationHarvard Univ, Div Cardiovasc Med, Brigham & Womens Hosp, Sch Med, Boston, MA 02215 USA
dc.description.affiliationUniversidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliationMcGill Univ, Ctr Hlth, Montreal, PQ, Canada
dc.description.affiliationCornell Univ, Weill Med Coll, New York, NY 10021 USA
dc.description.affiliationUniv Amsterdam, Acad Med Ctr, NL-1012 WX Amsterdam, Netherlands
dc.description.affiliationUniv Ulm, D-89069 Ulm, Germany
dc.description.affiliationHosp Cordoba, Cordoba, Argentina
dc.description.affiliationUniv Copenhagen, Herlev Hosp, Copenhagen Univ Hosp, DK-1168 Copenhagen, Denmark
dc.description.affiliationUniv Glasgow, Glasgow G12 8QQ, Lanark, Scotland
dc.description.affiliationSt Lukes Episcopal Hosp, Texas Heart Inst, Houston, TX USA
dc.description.affiliationUnifespUniversidade Federal de São Paulo, EPM, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipAstraZeneca
dc.format.extent616-623
dc.identifierhttp://dx.doi.org/10.1161/CIRCOUTCOMES.109.848473
dc.identifier.citationCirculation-cardiovascular Quality and Outcomes. Philadelphia: Lippincott Williams & Wilkins, v. 2, n. 6, p. 616-623, 2009.
dc.identifier.doi10.1161/CIRCOUTCOMES.109.848473
dc.identifier.issn1941-7713
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/31904
dc.identifier.wosWOS:000276078500015
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofCirculation-cardiovascular Quality and Outcomes
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectstatinsen
dc.subjectoutcomes researchen
dc.subjectprevention and controlen
dc.subjectepidemiologyen
dc.subjectprimary preventionen
dc.subjectrisk factorsen
dc.titleNumber Needed to Treat With Rosuvastatin to Prevent First Cardiovascular Events and Death Among Men and Women With Low Low-Density Lipoprotein Cholesterol and Elevated High-Sensitivity C-Reactive Protein Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)en
dc.typeinfo:eu-repo/semantics/article
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