Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein

Posted By Borja
N Engl J Med 2008;359:2195-207.
JUPITER Study Group*
Background
Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol, we hypothesized that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin treatment.
Methods
We randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes.
Results
The trial was stopped after a median follow-up of 1.9 years (maximum, 5.0). Rosuvastatin reduced LDL cholesterol levels by 50% and high-sensitivity C-reactive protein levels by 37%. The rates of the primary end point were 0.77 and 1.36 per 100 person- years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio for rosuvastatin, 0.56; 95% confidence interval [CI], 0.46 to 0.69; P<0.00001), p =" 0.0002)," p =" 0.002)," p =" 0.02).">

The Lancet 2008; 371:1587-1594
Posted by Joel Hernández
Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis
Dr Christopher A Pickett MD a , Prof Jeffrey L Jackson MD a c, Brian A Hemann MD a b and Prof J Edwin Atwood MD a b c
Background
Although carotid bruits are deemed to be markers of generalised atherosclerosis, they are poor predictors of cerebrovascular events. We investigated whether a carotid bruit predicts myocardial infarction and cardiovascular death.
Methods
In this meta-analysis, we searched Medline (1966 to August, 2007) and Embase (1974 to August, 2007) with the terms “carotid” and “bruit”. Bibliographies of all the retrieved articles were also searched. Articles were included if they reported the incidence of myocardial infarction or cardiovascular death in adults. Outcome variables were extracted in duplicate and included the rate of myocardial infarction and cardiovascular mortality. Quality of the articles was independently assessed with the Hayden rating scheme. Data were pooled with a random effects model.
Findings
Of the 22 articles included, 20 (91%) used prospective cohorts. Our analysis included 17 295 patients with 62 413·5 patient-years of follow-up, with a median sample size of 273 patients (range 38–4736) followed up for 4 years (2–7). The rate of myocardial infarction in patients with carotid bruits was 3·69 (95% CI 2·97–5·40) per 100 patient-years (eight studies) compared with 1·86 (0·24–3·48) per 100 patient-years in those without bruits (two studies). Yearly rates of cardiovascular death were also higher in patients with bruits (16 studies) than in those without (four studies) (2·85 [2·16–3·54] per 100 patient-years vs 1·11 [0·45–1·76] per 100 patient-years). In the four trials in which direct comparisons of patients with and without bruits were possible, the odds ratio for myocardial infarction was 2·15 (1·67–2·78) and for cardiovascular death 2·27 (1·49–3·49).
Interpretation
Auscultation for carotid bruits in patients at risk for heart disease could help select those who might benefit the most from an aggressive modification strategy for cardiovascular risk

Comments by Joel Hernández
Auscultation of a carotid bruit is considered (somewhat surprisingly) a poor predictor of cerebrovascular events. Nonetheless, these investigators concluded, in this meta-analysis, that carotid bruits are predictors of myocardial infarction and cardiovascular death. So, this is another risk factor to be kept in mind while assessing a patient´s cardiovascular risk. It´s also important to note that this is maybe a frequently forgotten part of the physical examination.