Who Might Be Eligible to Receive Statins for Primary Prevention?
Roughly four out of five older Americans might, according to results of the JUPITER trial.
Results of the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) demonstrated that the statin rosuvastatin reduced the risk for cardiovascular events in patients with elevated high-sensitivity C-reactive protein levels (hsCRP 2 mg/L) but with LDL levels below 130 mg/dL, the guideline indication for statin therapy (JW Cardiol Nov 10 2008). The impact of this study has been far-reaching, but, to date, no systematic estimates of its public health implications have been made.
In this analysis of NHANES data from 1999 to 2004, investigators estimated that nearly 60% of men aged 50 and women aged 60 (33.5 million Americans) have an indication for statin therapy according to current LDL-based guidelines; fewer than half of them are being treated. Using the JUPITER criteria, the investigators estimate that an additional 14% of the U.S. population (8.1 million individuals) would become eligible for statin treatment. Extending the JUPITER criteria to adults in the same age group with hsCRP levels 2 mg/L and LDL levels between 130 mg/dL and 160 mg/dL would add another 3.1 million individuals to this group. In total, based on these assumptions, statin therapy could be appropriate for nearly four out of five U.S. adults aged 50 or older.
Comment: This analysis quantifies the implications of the JUPITER results. JUPITER is the largest study to date to assess the role of statins in a demographically diverse patient population, including more than 7000 women. As these results confirm, many adults who are already eligible for statin treatment according to current guideline recommendations are not receiving it. If the JUPITER criteria were to be incorporated into guideline recommendations, millions more individuals — 80% of adults older than 50 — would become eligible for statin treatment.
Published in Journal Watch Cardiology February 11, 2009
Spatz ES et al. From here to JUPITER: Identifying new patients for statin therapy using data from the 1999–2004 National Health and Nutrition Examination Survey. Circ Cardiovasc Qual Outcomes 2009 Jan; 2:41.
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