Abstract
Over the last two decades statins have become indispensable for managing patients at high risk of cardiovascular disease. Since their introduction in the late 1980s, their role has expanded from drugs to be used in secondary prevention to standard treatment in primary prevention for individuals at high risk of cardiovascular disease. Targets for low-density lipoprotein (LDL) cholesterol, as well as LDL levels at which statin therapy should be started, have gradually gone down. The JUPITER study succeeded in expanding the limits of earlier interventions and aimed for lower plasma LDL cholesterol levels, as well as including high-sensitivity C-reactive protein (hs-CRP) as a biomarker for risk and target for treatment. The investigators included patients who, according to current guidelines, would not qualify for statin therapy. Patients with elevated levels of hs-CRP (>2mg/dl) and low LDL cholesterol (<130mg/dl) were treated with rosuvastatin 20mg or placebo. The trial was terminated after 1.9 years because of unexpected early benefits, whereby the relative risk of developing atherothrombotic complications was reduced by 44%. The implications of this trial are far-reaching, not only because of the public health consequences of treating a larger number of individuals with aggressive statin therapy than current guidelines dictate; it also forces us to re-evaluate current cardiovascular risk calculating tools. The provocative results of this important primary prevention trial have generated new questions on how to intervene earlier in the development of atherosclerosis in patients at risk of cardiovascular disease.

Keywords
JUPITER trial, cholesterol, C-reactive protein, coronary artery disease, primary prevention, statin drugs, cardiovascular risk, heart risk factors, lipoprotein (a), low-density lipoprotein, high-density lipoprotein, preventative cardiology, metabolic syndrome, cardiovascular screening, rosuvastatin, statin drugs, HMG CoA reductase inhibitors
Disclosure: Peter J Lansberg is on the speaker’s bureau for Merck Sharp & Dohme, Schering Plough, Pfizer, AstraZeneca and Genzyme, and is on Pfizer’s advisory board.
Received: 6 August 2009 Accepted: 19 October 2009
Correspondence: Peter J Lansberg, Co-ordinator, Durrer Centre for Cardiogenetic Research, Department of Vascular Medicine F4-159.2, Academic Medical Centre, Amsterdam, The Netherlands. E: p.j.lansberg@amc.uva.nl