JUPITER — Rosuvastatin in Healthy Adults with Elevated hsCRP

Design

JUPITER randomised 17,802 adults with LDL <130 mg/dL and hsCRP ≥2 mg/L to rosuvastatin 20 mg/day or placebo. Median follow-up was 1.9 years; the trial was halted early for efficacy.

Findings

• Primary composite endpoint (MI, stroke, hospitalisation for unstable angina, revascularisation, cardiovascular death): 44% relative reduction.
• Individually: MI down 54%, stroke down 48%.
• All-cause mortality: 20% reduction.
• Numerically small increase in incident diabetes (now considered a real, modest statin side effect).

Why it matters

JUPITER established two things:

1. Statins benefit primary-prevention populations with normal LDL who are at elevated risk by an alternative marker (hsCRP).
2. Inflammation matters in cardiovascular biology, complementing lipid pathways — a precursor to CANTOS years later.

Criticisms

• Stopped early; effect sizes may be overstated.
• Generalisability to lower-risk populations.
• Number needed to treat was relatively high for some endpoints.

Despite the debate, JUPITER changed practice: hsCRP became an accepted risk-reclassification tool, and statin prescribing thresholds broadened.

Related entries

Statins, hsCRP, CANTOS, Cardiovascular disease.