A Randomized Trial of Rosuvastatin in the Prevention of Venous Thromboembolism: the JUPITER Trial
By Robert J. Glynn, E. Danielson, F. Fonseca, J. Genest, A. Gotto, J. Kastelein, W. Koenig, Peter Libby, A. Lorenzatti, Jean G Macfadyen and 4 more. New England Journal of Medicine, 2009
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Background Controversies persist on whether arterial and venous thrombosis share common pathways and whether treatments of known efficacy for one disease process have consistent benefits for the other. Observational studies have yielded variable estimates of the effect of statin therapy on risk of venous thromboembolism, and randomized evidence is lacking. Methods Symptomatic venous thromboembolism was a pre-specified endpoint of Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER). We randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg/dL and high-sensitivity C-reactive protein levels of 2.0 mg/L or higher to rosuvastatin, 20 mg/d, or placebo. Intention-to-treat analyses followed participants for the first occurrence of pulmonary embolism or deep vein thrombosis. Results During a median follow-up of 1.9 years (maximum 5.0), symptomatic venous thromboembolism occurred in 94 participants, 34 in the rosuvastatin group and 60 in the placebo group. The rates of venous thromboembolism were 0.18 and 0.32 per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio for rosuvastatin 0.57; 95% confidence interval [CI], 0.37 to 0.86; P=0.007), with corresponding rates of 0.10 and 0.17 for unprovoked venous thromboembolism (hazard ratio 0.61; 95% CI, 0.35 to 1.09; P=0.089) and 0.08 and 0.16 for provoked venous thromboembolism (hazard ratio 0.52; 95% CI, 0.28 to 0.96; P=0.033). Corresponding rates of pulmonary embolism were 0.09 and 0.12 (hazard ratio 0.77; 95% CI, 0.41 to 1.45; P=0.42), whereas rates of deep vein thrombosis only were 0.09 and 0.20 (hazard ratio 0.45; 95% CI, 0.25 to 0.79; P=0.004). Consistent effects were observed in all subgroups examined. No differences were seen between treatment groups in rates of bleeding. Conclusions In this trial of apparently healthy persons, rosuvastatin significantly reduced the occurrence of symptomatic venous thromboembolism. (ClinicalTrials.gov number, NCT00239681.)
Subfields: Cancer Research, Cardiology and Cardiovascular Medicine, Internal Medicine
View Paper: https://www.semanticscholar.org/paper/96ec6033f264ff7153214e7a3af3fc3938fc01ab
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Citations in the corpus
- New fundamentals in hemostasis. (2013, background): “Recent epidemiological studies have also provided intriguing evidence that treatment with statins may reduce the risk of (recurrent) VTE by as much as 30–50% both during and after anticoagulant treatment (106, 238, 251).”
- Pleiotropic Effects of Statins on the Cardiovascular System (2017, background): “percholesterolemia is not a particularly strong risk factor for venous thromboembolism.(31)”
- Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions. (2010, background): “Rosuvastatin is known to have anti-inflammatory effects in addition to lipid-lowering effects (Glynn et al., 2009).”