This article is more than 5 years old. Information may no longer be current.
JUPITER data could expand numberof older U.S. adults who may benefit from statin therapy
Approximately 80% of adults may now have an indication for statin therapy.
Click Here to Manage Email Alerts
More than 11 million older Americans may be eligible for statin therapy, according to findings from a new analysis of the JUPITER trial.
Current National Cholesterol Education Program/Adult Treatment Panel III guidelines for statin use focus on patients with elevated LDL levels >130 mg/dL. Using data from the 1999–2004 National Health and Nutrition Examination Survey, researchers at Yale University reported that 33.5 million men aged 50 years or older and women aged 60 years or older (57.9%) are currently taking a statin (24.4%) or have risks factors that would indicate a need for statin therapy (33.5%).
However, findings from the JUPITER trial, which was released in November 2008, indicated that statin therapy is also effective in older adults with elevated high-sensitivity C-reactive protein levels >2 mg/L. On the basis of both existing guidelines and those based on the JUPITER results, new estimates are much higher, according to the analysis published in Circulation: Cardiovascular Quality and Outcomes.
Extending JUPITER findings
The aim of the JUPITER trial was to examine whether statin therapy reduced CV risk in patients with at-goal cholesterol levels and elevated levels of high-sensitivity C-reactive protein. Researchers randomly assigned men aged 50 years or older and women aged 60 years or older to rosuvastatin (Crestor, AstraZeneca) or placebo. However, the trial was terminated early after interim analysis showed greater benefits in CV events and deaths among patients assigned rosuvastatin compared with patients assigned placebo. The data were presented at the American Heart Association Scientific Sessions 2008.
“Our suspicion was that the findings from JUPITER might potentially impact a sizeable number of older adults in the United States; the question for us was how many more people might now have an indication to take a statin medication under these criteria,” Erica S. Spatz, MD, internist and fellow in the Robert Wood Johnson Clinical Scholars Program at Yale University, said in a press release.
Spatz and colleagues evaluated data from a subset of 2,322 older men and women who responded to the NHANES survey and who allowed researchers to take a fasting blood sample. Researchers tested the blood samples for a variety of CV risk factors including cholesterol level and level of high-sensitivity C-reactive protein.
“Based on our analysis, more than 44.7 million older Americans might have an indication for statin therapy when you consider those who already meet current guidelines for statin therapy and those who might be eligible based on the criteria proposed in JUPITER,” she said.
An estimated 19.2% of the adult population may become newly eligible for statin therapy, according to Spatz. That number includes 8,071,000 people (13.9%) with high-sensitivity C-reactive protein levels >2 mg/L and LDL levels, 130 mg/dL and an additional 3,073,000 (5.3%) with high-sensitivity C-reactive protein levels >2 mg/L and LDL levels between 130 mg/dL and 160 mg/dL.
The analysis revealed that sociodemographic factors and CV characteristics of the JUPITER population are similar to adults with an already established indication for statin therapy. Both groups were similar in age, race/ethnicity and socioeconomic status. The JUPITER population was more likely to be female, older, obese and have hypertension and metabolic syndrome compared with individuals with no indication for statin use.
“This further suggests we may be missing a group of people who in addition to having an elevated high-sensitivity C-reactive protein have other features that put them at risk for heart disease, and for whom a statin medication may be beneficial,” Spatz said. – by Katie Kalvaitis
Circ Cardiovasc Qual Outcomes. 2009;2:41-48.