Author + information
- Received July 13, 2009
- Revision received September 23, 2009
- Accepted October 12, 2009
- Published online December 15, 2009.
- Eric Y. Yang, MD*,†,
- Vijay Nambi, MD*,†,
- Zhengzheng Tang, MS§,
- Salim S. Virani, MD*,†,
- Eric Boerwinkle, PhD‡,
- Ron C. Hoogeveen, PhD*,†,
- Brad C. Astor, PhD∥,
- Thomas H. Mosley, PhD¶,
- Josef Coresh, MD, PhD∥,
- Lloyd Chambless, PhD§ and
- Christie M. Ballantyne, MD*,†,* ()
- ↵*Reprint requests and correspondence:
Dr. Christie M. Ballantyne, Baylor College of Medicine, Methodist Debakey Heart and Vascular Center, 6565 Fannin Street, STE B160/M.S. A-601, Houston, Texas 77030
Objectives The purpose of this study is to describe the proportion of “JUPITER-eligible” (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) individuals and clinical outcomes of individuals based on high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C) strata in the ARIC (Atherosclerosis Risk in Communities) study.
Background Questions remain after the JUPITER study, including whether the observed cardiovascular disease (CVD) event rates would persist with time and how these event rates would compare with other populations (lower hs-CRP and/or higher LDL-C levels).
Methods After stratification into 4 groups based on LDL-C and hs-CRP levels, with cutoffs at 130 mg/dl and 2.0 mg/l, respectively, incident CVD events were examined (mean follow-up, 6.9 years) and compared.
Results Of 8,907 age-eligible participants, 18.2% (n = 1,621) were JUPITER-eligible (hs-CRP ≥2.0 mg/l, LDL-C <130 mg/dl) and had an absolute CVD risk of ∼10.9% over a mean follow-up of 6.9 years (1.57% per year). If JUPITER hazard ratios were applied to this group, the number needed to treat to prevent 1 CVD event would be estimated at 38 over 5 years and 26 over 6.9 years.
Conclusions ARIC participants with elevated hs-CRP and low LDL-C had a CVD event rate of 1.57% per year over 6.9 years, similar to the CVD event rate noted in the JUPITER study placebo group (1.36% per year over 1.9 years). The association of hs-CRP ≥2.0 mg/l with increased CVD risk and mortality regardless of LDL-C provides us a simple method of using age and hs-CRP level for identifying higher risk individuals. (Atherosclerosis Risk in Communities study; NCT00005131)
The ARIC study is a collaborative study supported by contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022 from the National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland. Dr. Nambi has a research collaboration with General Electric, and has participated in clinical research conducted by KOWA, Abbott, GlaxoSmithKline, Merck/Schering-Plough, Roche, and Genzyme. Dr. Virani is on the Speakers' Bureau for Abbott and Daiichi-Sankyo. Dr. Ballantyne is a consultant for Abbott, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, KOWA, Merck, Merck/Schering-Plough, Metabasis, Novartis, Pfizer, Sanofi-Synthelabo, Schering-Plough, and Takeda; receives grant/research support from Abbott, AstraZeneca, GlaxoSmithKline, Merck, Sanofi-Synthelabo, Schering-Plough, and Takeda; has received honoraria from Abbott, AstraZeneca, GlaxoSmithKline, Merck, Merck/Schering-Plough, Novartis, Pfizer, Sanofi-Synthelabo, Schering-Plough, and Takeda; and is on the Speakers' Bureau for AstraZeneca, GlaxoSmithKline, Merck, Merck/Schering-Plough, Pfizer, and Schering-Plough. Drs. Yang and Nambi contributed equally to this work.
- Received July 13, 2009.
- Revision received September 23, 2009.
- Accepted October 12, 2009.
- American College of Cardiology Foundation