Rosuvastatin in the Prevention of Stroke Among Men and Women With Elevated Levels of C-Reactive Protein Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)
Rosuvastatin in the Prevention of Stroke Among Men and Women With Elevated Levels of C-Reactive Protein Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)
复制标题
DOI：
10.1161/circulationaha.109.874834
复制
发表时间：
2010-01-05
期刊：
影响因子：
37.8
通讯作者：
Ridker, Paul M.
中科院分区：
文献类型：
--
作者：
Everett, Brendan M.;Glynn, Robert J.;Ridker, Paul M.
背景-既往采用胆固醇标准进行的他汀类药物治疗的一级预防试验并未报道卒中风险的显著降低。我们评估了他汀类药物治疗是否可以降低胆固醇水平低但高敏C反应蛋白水平升高的个体的卒中发生率。一项评价瑞舒伐他汀的干预试验（JUPITER），17 802名低密度脂蛋白胆固醇水平≥ 2.0 mg/kg的表面健康男性和女性L被随机分配至瑞舒伐他汀20 mg/天或安慰剂组，然后随访首次卒中的发生。经过1.9年的中位随访，（最长，5.0年），与安慰剂相比，瑞舒伐他汀导致致死性和非致死性卒中的风险降低48%（发病率分别为0.18和0.34/100观察人年;风险比为0.52; 95%置信区间为0.34 - 0.79; P=0.002），这一发现在所有检查的亚组中一致。这一发现是由于缺血性中风的发生率降低了51%（风险比，0.49; 95%置信区间，0.30 - 0.81; P=0.004），活性组和安慰剂组之间出血性卒中的发生率无差异（风险比，0.67; 95%置信区间，0.24至1.88;结论：瑞舒伐他汀可使低水平低血糖的男性和女性缺血性卒中的发病率降低一半以上。高密度脂蛋白胆固醇水平的人，因为高敏感性C反应蛋白水平升高而处于危险之中。
Background-Prior primary prevention trials of statin therapy that used cholesterol criteria for enrollment have not reported significant decreases in stroke risk. We evaluated whether statin therapy might reduce stroke rates among individuals with low levels of cholesterol but elevated levels of high-sensitivity C-reactive protein.Methods and Results-In Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), 17 802 apparently healthy men and women with low-density lipoprotein cholesterol levels = 2.0 mg/L were randomly allocated to rosuvastatin 20 mg daily or placebo and then followed up for the occurrence of a first stroke. After a median follow-up of 1.9 years (maximum, 5.0 years), rosuvastatin resulted in a 48% reduction in the hazard of fatal and nonfatal stroke as compared with placebo (incidence rate, 0.18 and 0.34 per 100 person-years of observation, respectively; hazard ratio 0.52; 95% confidence interval, 0.34 to 0.79; P=0.002), a finding that was consistent across all examined subgroups. This finding was due to a 51% reduction in the rate of ischemic stroke (hazard ratio, 0.49; 95% confidence interval, 0.30 to 0.81; P=0.004), with no difference in the rates of hemorrhagic stroke between the active and placebo arms (hazard ratio, 0.67; 95% confidence interval, 0.24 to 1.88; P=0.44).Conclusion-Rosuvastatin reduces by more than half the incidence of ischemic stroke among men and women with low levels of low-density lipoprotein cholesterol levels who are at risk because of elevated levels of high-sensitivity C-reactive protein.