JUPITER Subanalysis: Reduction of LDL Determines Clinical Impact of Rosuvastatin Therapy

Original Title: Cholesterol treatment targets and clinical outcomes: a JUPITER trial update.
Presenter: Paul Ridker.

The lower the LDL cholesterol levels, the less adverse cardiovascular events in men and women initially healthy, according to an analysis of the JUPITER trial. Findings could help inform about the optimal LDL goals in primary prevention.

To explore the link between percent reduction of LDL and outcomes, Ridker and colleagues analyzed data from the JUPITER trial that included 17,802 patients initially healthy randomized to 20 mg of rosuvastatin (Crestor; AstraZeneca) or placebo, followed up through five years.

Median percent reduction in LDL cholesterol with rosuvastatin was 50%, despite the ample variability across the study population. A small proportion of patients saw no LDL reduction, half saw at least a 50% drop, and the rest, a smaller reduction.

The rate of first-ever MI, stroke, hospitalization for unstable angina requiring coronary intervention, or cardiovascular death (primary endpoint) per 1,000 person-years was 11.2 with placebo, 9.2 for those with no reduction in LDL cholesterol (RR 0.86), 6.7 for those with a less than 50% reduction (RR 0.61), and 4.8 for those with at least a 50% reduction (RR 0.41; P <0.00001 for trend).

The findings could be relevant now that PCSK9 inhibitors are emerging as a new class of lipid-lowering drugs. Patients with large reductions in LDL cholesterol on statins would see, in theory, less benefits with the new agents and those with smaller or no reductions would possibly have the most benefits.