FROM ACC 2009 : JUPITER RE-VISITED

Well, as expected, this ACC 2009 at Orlando will have a few re-visits on the JUPITER ( the use of rosuvastatin in the primary prevention of CAD ) results that were presented last year. One of the early presentations yesterday was a re-analysis of the JUPITER data looking to see which is the best subsets, in terms of biochemical parameters, that will benefit from the use of statin therapy. It was obvious from the re-analysis, that patients or rather subjects ( since this is a primary prevention study ) with low LDL-C and low hs-CRP has the best long term outcome with the use of statins.
I must say that this JUPITER re-analysis of the data and the results are not surprising. We knew this almost 5 years ago when we had a look at the PROVE-IT data. In that study, the statin used was Atorvastatin. A close look at the Prove-IT data aklso showed that the subjects with low LDL-C and hs-CRP had the best outcome.
Well, it would appear that LDL-C was not the only reason for less cardiac events, with the use of statins. This is inline with the current theory that atherosclerosis may have a large inflammatory component, in many patients, and hs-CRP is a measure of the amount of inflammation and that statins here may be acting on the vessel wall as an inflammatory agent.
This on the whole is easy for clinician. BUT what we have learned is that hs-CRP is something that is not easy to measure. The spread of normality is so wide, that clinicians sometimes have difficulty trying to understand the results. Any small source of infection or inflammation, will raise the CRP and give us spurious readings. I will always interprete the hs-CRP ( especially with our labs ) with a common ESR finding. If the ESR is also raised, that hs-CRP reading showed be ignored. Do not frighten the patient. I am certain that with the strong push from JUPITER, labs will begin to standardise their techniques better and allow us a better hs-CRP assessment kit. In the meantime, know that statins work, both by lowering LDL-C and also by lowering hs-CRP. The lower the LDL-C and hs-CRP, the better for your heart and arteries in the long run.