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Evevident
Original paper
2008NEJMPreventive/Primary Care

JUPITER

Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein

RCTPrimary prevention

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Overview

Rosuvastatin reduced first cardiovascular events in adults with normal LDL but elevated hsCRP.

Clinical takeaway

JUPITER expanded statin-prevention thinking beyond LDL alone, but its selected high-inflammatory-risk population and early stopping matter when applying it.

Key result

Major vascular events were reduced with rosuvastatin; HR 0.56 for the primary composite.

Practice impact

Helped move primary-prevention statin decisions toward absolute risk rather than LDL thresholds alone.

Evidence

Study design

Randomized, double-blind, placebo-controlled trial stopped early for benefit.

Enrollment

17,802

Follow-up

Median 1.9 years.

Geography

Multinational

Clinical question

Does rosuvastatin prevent first major cardiovascular events in apparently healthy adults with LDL <130 mg/dL and hsCRP >=2 mg/L?

Population

  • Men >=50 and women >=60 without cardiovascular disease or diabetes.
  • LDL cholesterol <130 mg/dL and high-sensitivity C-reactive protein >=2 mg/L.

Intervention

Rosuvastatin 20 mg daily.

Comparator

Placebo.

Primary outcome

First major cardiovascular event: MI, stroke, arterial revascularization, hospitalization for unstable angina, or cardiovascular death.

Rosuvastatin significantly reduced first major cardiovascular events in selected adults with elevated hsCRP.

Hazard ratio / 0.56 / CI 95% CI 0.46-0.69 / p=<0.00001

Key results

  • Primary composite: HR 0.56; 95% CI 0.46-0.69; p<0.00001.
  • Trial stopped early after a median 1.9 years.
  • Physician-reported diabetes was more frequent with rosuvastatin.

Harms

  • Physician-reported diabetes was more common in the rosuvastatin group.
  • Myopathy and liver toxicity were not major excess signals in the trial.

Clinical Use

When to cite

  • When discussing primary-prevention statins in patients without high LDL but with elevated risk.

Practice impact

  • Strengthened the case for statins in selected primary-prevention patients at elevated inflammatory or global cardiovascular risk.

Applicability

  • Most applicable to older adults without known ASCVD who have low-to-moderate LDL but elevated hsCRP and sufficient absolute risk.

Limitations

  • Early stopping can overestimate treatment effect.
  • The trial population was selected by hsCRP and does not mean everyone with low LDL needs a statin.

Common misinterpretations

  • Do not cite JUPITER as proof that hsCRP screening alone should drive statin use; current practice emphasizes pooled absolute risk and shared decision-making.

Related evidence

4S - Contrasting ResultFOURIER - Context

Citation

Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195-2207. doi:10.1056/NEJMoa0807646

Rosuvastatin significantly reduced the incidence of major cardiovascular events.