Race and the Efficacy of Rosuvastatin in Primary Prevention
Race and the Efficacy of Rosuvastatin in Primary Prevention
Objectives The aim of this study was to evaluate the effect of statin treatment in primary prevention of cardiovascular events in different race/ethnic groups.
Background Clinical trial evidence about the efficacy of statins in the primary prevention of cardiovascular events among nonwhites is uncertain.
Methods JUPITER trial, a randomized, double-blind, placebo-controlled evaluation of rosuvastatin 20 mg in the primary prevention of myocardial infarction (MI), stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death included 12,683 whites and 5,117 nonwhites with low-density lipoprotein levels <130 mg/dL and high-sensitivity C-reactive protein levels ≥2.0 mg/L.
Results Random allocation to rosuvastatin resulted in a 45% reduction in the primary end point among whites (hazard ratio [HR] 0.55, 95% CI 0.43–0.69) and a 37% reduction among nonwhites (HR 0.63, 95% CI 0.41–0.99). Blacks (HR 0.65, 95% CI 0.35–1.22) and Hispanics (HR 0.58, 95% CI 0.25–1.39) had similar risk reductions. Among nonwhites in the placebo group, the stroke rate exceeded the MI rate (0.44 vs 0.20 per 100 person-years); an opposite pattern was observed among whites (0.31 vs 0.42 per 100 person-years). Nonwhites had higher death rates than whites (2.25 vs 0.93 per 100 person-years); however, all-cause mortality was similar at 20% with rosuvastatin treatment in both participant groups.
Conclusions When used in primary prevention among individuals with low-density lipoprotein <130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L, rosuvastatin significantly reduced first MI, stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death among whites and nonwhites.
Although statin therapy has proven highly effective in the primary prevention of cardiovascular events in white populations, clinical trial data among nonwhites are scarce. For example, the WOSCOPS of 6,595 men and the AFCAPS/TEXCAPS of 6,605 participants together included <1,000 blacks and 500 Hispanics. Consequently, it remains uncertain whether statins are similarly beneficial in primary prevention in nonwhite populations. JUPITER trial was a randomized, double-blind, placebo-controlled primary prevention trial that investigated whether individuals with average low-density lipoprotein (LDL-C) but elevated high-sensitivity C-reactive protein (CRP) (hsCRP) levels would benefit from statin therapy. As previously reported, among 17,802 participants with LDL-C <130 mg/dL and hsCRP ≥2 mg/L, rosuvastatin allocation was associated with a 54% reduction in myocardial infarction (MI) (P = .0002), a 48% reduction in stroke (P = .002), a 46% reduction in need for bypass surgery or angioplasty (P < .001), a 43% reduction in venous thromboembolism (P = .007), and a 20% reduction in all-cause mortality (P = .02) over a median follow-up of 1.9 years. Because JUPITER enrolled 12,683 whites and 5,117 nonwhites, it afforded the opportunity to examine if statin treatment would be effective in primary prevention in nonwhites in a post hoc manner.
Abstract and Introduction
Abstract
Objectives The aim of this study was to evaluate the effect of statin treatment in primary prevention of cardiovascular events in different race/ethnic groups.
Background Clinical trial evidence about the efficacy of statins in the primary prevention of cardiovascular events among nonwhites is uncertain.
Methods JUPITER trial, a randomized, double-blind, placebo-controlled evaluation of rosuvastatin 20 mg in the primary prevention of myocardial infarction (MI), stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death included 12,683 whites and 5,117 nonwhites with low-density lipoprotein levels <130 mg/dL and high-sensitivity C-reactive protein levels ≥2.0 mg/L.
Results Random allocation to rosuvastatin resulted in a 45% reduction in the primary end point among whites (hazard ratio [HR] 0.55, 95% CI 0.43–0.69) and a 37% reduction among nonwhites (HR 0.63, 95% CI 0.41–0.99). Blacks (HR 0.65, 95% CI 0.35–1.22) and Hispanics (HR 0.58, 95% CI 0.25–1.39) had similar risk reductions. Among nonwhites in the placebo group, the stroke rate exceeded the MI rate (0.44 vs 0.20 per 100 person-years); an opposite pattern was observed among whites (0.31 vs 0.42 per 100 person-years). Nonwhites had higher death rates than whites (2.25 vs 0.93 per 100 person-years); however, all-cause mortality was similar at 20% with rosuvastatin treatment in both participant groups.
Conclusions When used in primary prevention among individuals with low-density lipoprotein <130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L, rosuvastatin significantly reduced first MI, stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death among whites and nonwhites.
Introduction
Although statin therapy has proven highly effective in the primary prevention of cardiovascular events in white populations, clinical trial data among nonwhites are scarce. For example, the WOSCOPS of 6,595 men and the AFCAPS/TEXCAPS of 6,605 participants together included <1,000 blacks and 500 Hispanics. Consequently, it remains uncertain whether statins are similarly beneficial in primary prevention in nonwhite populations. JUPITER trial was a randomized, double-blind, placebo-controlled primary prevention trial that investigated whether individuals with average low-density lipoprotein (LDL-C) but elevated high-sensitivity C-reactive protein (CRP) (hsCRP) levels would benefit from statin therapy. As previously reported, among 17,802 participants with LDL-C <130 mg/dL and hsCRP ≥2 mg/L, rosuvastatin allocation was associated with a 54% reduction in myocardial infarction (MI) (P = .0002), a 48% reduction in stroke (P = .002), a 46% reduction in need for bypass surgery or angioplasty (P < .001), a 43% reduction in venous thromboembolism (P = .007), and a 20% reduction in all-cause mortality (P = .02) over a median follow-up of 1.9 years. Because JUPITER enrolled 12,683 whites and 5,117 nonwhites, it afforded the opportunity to examine if statin treatment would be effective in primary prevention in nonwhites in a post hoc manner.
