Clinical implications of JUPITER in a contemporary European population: the EPIC-Norfolk prospective population study

Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) has raised several points of debate. We quantified the proportion of individuals meeting the JUPITER criteria, determined their risk profile, and their risk of coronary heart disease (CHD) events during a long-term follow-up in a contemporary European cohort. A total of 25 639 participants aged between 45 and 79 years were followed for 11.4 ± 2.8 years in EPIC-Norfolk population cohort. A total of 8397 individuals with complete data available were considered potentially eligible for primary prevention. A total of 846 (10.1%) individuals fulfilled the JUPITER criteria [low-density lipoprotein cholesterol-C (LDL-C) <3.4 mmol/L/C-reactive protein ≥ 2 mg]. This group had a 10-person-year event rate of 14.6% compared with 7.0% for those with LDL-C <3.4 mmol/L/C-reactive protein <2 mg (P = 0.001); the corresponding adjusted hazard ratio for future CHD was 1.70 (95% CI: 1.31-2.21). The group fulfilling JUPITER criteria had significantly higher CHD risk compared with those with LDL-C ≥ 3.4 mmol/L and C-reactive protein <2 mg/L. Among individuals who did not qualify for statin therapy based on the Society of Cardiology Systematic COronary Risk Evaluation (SCORE) (n = 4652) or ATP III criteria (n = 4466), 18.1 and 18.9%, respectively, would have qualified using the JUPITER criteria. In this European cohort, JUPITER-eligible individuals had significantly higher event rates compared with those with LDL-C <3.4 mmol/L/C-reactive protein <2 mg and LDL-C ≥ 3.4 mmol/L/C-reactive protein <2 mg/L. Application of the JUPITER criteria qualified almost one-fifth of the population for statin therapy that otherwise would not have qualified based on SCORE or ATP III criteria