Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy

Lorgeril, Michel de; Salen, Patricia; Abramson, John; Dodin, Sylvie; Hamazaki, Tomohito; Kostucki, Willy; Okuyama, Harumi; Pavy, B.; Rabaeus, Mikael

doi:10.1001/archinternmed.2010.184

Cited by 125 publications

(99 citation statements)

References 49 publications

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“…Moreover, in spite of the lack of double-blind, randomized controlled trials with atorvastatin in advanced heart failure patients, in the TNT study, high-dose atorvastatin reduced the need for hospitalization of heart failure patients without advanced heart failure in a subgroup analysis [14]. It should also be considered that the rosuvastatin results may be weakened by some potential flaws in the JUPITER study, including early study termination, discrepancy in CV outcomes, and the controversial use of high sensitivity C-reactive protein as a predictor of CV risk [15,16]. In the scenario described above, rosuvastatin may not be beneficial in the prevention of CVD.…”

Section: Reprint Frommentioning

confidence: 99%

Benefits of Rosuvastatin in Cardiovascular Protection Remain Unclear After HOPE-3

Chang¹,

Hwu²,

Kao³

et al. 2016

Rev Diabet Stud

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he use of commercialized statins in the prevention of cardiovascular diseases (CVD) has commonly been accepted based on the informative results of the Cholesterol Treatment Trialists (CTT) reports [1] As an additional effort in the prevention of CVD, professional societies have issued practical recommendations for healthcare providers on the effective use of statins in lowering low-density-lipoprotein cholesterol (LDL-C) [2]. Among these statins, atorvastatin and rosuvastatin are regarded as the most effective as they can reduce more than 30% of LDL-C, even at low doses (i.e. atorvastatin 10 mg; rosuvastatin 5 mg) [2]. The results of the recent HOPE-3 study [3], in which 10 mg rosuvastatin was found to reduce the development of CVD by 24% in intermediate-risk persons, may reinforce the role of rosuvastatin in CVD prevention. However, there are some concerns regarding the use of rosuvastatin.Based on the CTT report [1] and our recent literature review [4], 6 atorvastatin and 4 rosuvastatin studies, characterized by their rigorous double-blind, randomized, placebo-controlled study designs, have been published in the past two decades. A meta-analysis using a random effect model showed that atorvastatin significantly reduced the risk of CVD, with an odds ratio (OR) of 0.82 (95% CI: 0.75-0.90, p <0.001, Figure 1). In contrast, the results of a meta-analysis including the 4 rosuvastatin trials failed to detect a significant reduction in CVD risk, with an OR of 0.86 (0.69-1.07, p = 0.163). Surprisingly, the effect of rosuvastatin in CVD risk prevention remained controversial, even after inclusion of the encouraging HOPE-3 study [3] in the analysis, which then yielded an overall OR of 0.84 (0.70-1

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Section: Reprint Frommentioning

confidence: 99%

Benefits of Rosuvastatin in Cardiovascular Protection Remain Unclear After HOPE-3

Chang¹,

Hwu²,

Kao³

et al. 2016

Rev Diabet Stud

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“…Critical Reappraisal of Cholesterol Lowering therapy in prevention of Cardiovascular Diseases "JUPITER trial" elucidates that the results of trials do not support the use of statin treatment for primary prevention of cardiovascular diseases and raises troubling questions concerning the role of commercial sponsors [17].…”

Section: Review Of the Statin Sagamentioning

confidence: 99%

The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns

Sultan¹,

Hynes²

2013

OJEMD

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Cardio-vascular specialists have witnessed and actively participated in the revolutionary developments that have occurred in their field of specialization over the last few years. Cutting-edge technologies have led to dramatic improvements in life-expectancy and quality of life. An open-mind and pioneering attitude are necessary when exploring new frontiers to improve our patients' health. However, naïve indiscriminate acceptance of novel mainstream therapies is not always advisable and prudence is required in unearthing harmful, covert side effects. An objective review of contemporary vascular research was performed and industrial bias was sifted out for a fresh prospective on how to promote primary cardiovascular prevention with attainable lifestyle adjustments [1]. A comprehensive review of Pubmed, EM-BASE and Cochrane review databases was undertaken for articles relating to cardiovascular primary prevention and statin side effects with the aim of harmonising their roles within contemporary clinic practice. Particular attention was paid to large-scale randomised controlled trials on contemporary cardiovascular pharmacotherapies and their specific adverse effects on metabolic pathways which feature prominently in cardiovascular primary prevention and regenerative programmes. There is a categorical lack of clinical evidence to support the use of statin therapy in primary prevention. Not only is there a dearth of evidence for primary cardiovascular protection, there is ample evidence to show that statins actually augment cardiovascular risk in women, patients with Diabetes Mellitus and in the young. Furthermore statins are associated with triple the risk of coronary artery and aortic artery calcification. Cardiovascular primary prevention and regeneration programmes, through life style changes and abstaining from tobacco use have enhanced clinical efficacy and quality of life over any pharmaceutical or other conventional intervention.

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“…The estimated NNT was 133, 61 and 40, for those at low, intermediate and high risk, respectively; which is only about a doubling compared with secondary prevention 10 . The debate continues in a recent issue of Archives of Internal Medicine which includes articles and an editorial devoted to the conundrum of whether primary prevention with statins is justified 5,11,12,13 . The meta-analysis by Ray and colleagues 5 was prompted by another one published in 2009 in the BMJ 4 .…”

Section: The Meta-analyses Of 2009 and 2010mentioning

confidence: 99%

“…In contrast to Brugts and coworkers 4 , Ray et al 5 did not perform an analysis excluding JUPITER probably because it would not add to their conclusion that primary prevention was not worthwhile. Instead they attempted to set JUPITER in context and argued as have others 11,12 that JUPITER may represent extreme or exaggerated effects.…”

Section: The Meta-analyses Of 2009 and 2010mentioning

confidence: 99%

“…There may also be groups where there is no clinical evidence of vascular disease but the future risk is great, such as rheumatoid arthritis and similar disorders 57,58 . After JUPITER, the value of measuring hsCRP levels in identifying vascular risk will also need to be established [11][12][13]19,59 . However, this topic is the subject of considerable debate and is beyond the scope of this editorial 59 .…”

Section: Identifying Vascular Riskmentioning

confidence: 99%

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Primary prevention using statins: to be or not to be?

Breimer

Mikhailidis

2010

Current Medical Research and Opinion

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Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy

Cited by 125 publications

References 49 publications

Benefits of Rosuvastatin in Cardiovascular Protection Remain Unclear After HOPE-3

Benefits of Rosuvastatin in Cardiovascular Protection Remain Unclear After HOPE-3

The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns

Primary prevention using statins: to be or not to be?

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