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Independents' Day

JUPITER offers some valuable lessons on rosuvastatin - but it's not the full picture

I read with interest your article concerning the JUPITER study.

Certainly it is of great significance, with benefits in reducing the risk of cardiovascular events or death (44% reduction versus placebo) in patients with already relatively low LDL levels (less than 3.4 mmol/l).

However, like all studies there are caveats:

1. Patients in the study had raised levels of high-sensitivity C-reactive protein (hsCRP) of 2mg/l or more, which is an independent risk factor for development of cardiovascular disease.

This marker is not widely available in the UK and one of the main lessons from the study might be the benefit of using hsCRP more widely to identify patients at high cardiovascular risk.

2. Recruitment for the study involved initial detailed exemption criteria followed by screening of potential trial participants for hsCRP levels. For the final nearly 18,000 patients recruited to the trial, nearly 90,000 had to be screened. This illustrates that the results cannot be directly applied to the general patient population.

3. The number needed to treat to prevent an event in JUPITER was 120, meaning 120 patients needed to be treated with rosuvastatin 20mg per day for nearly two years to prevent one event. If you factor in the pre-screening, the number needed to treat to get the same result from the general population might be as high as 600.

4. There was also a statistically significant increase in risk of diabetes in the rosuvastatin population.

Therefore yes, the study is very significant for rosuvastatin, given it provides the drug firm with end-point data. But as in many things, the devil is in the detail.

Dr Jim McMorran, Coventry

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