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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents findings from another prespecified analysis of the JUPITER data, assessing the effect of rosuvastatin on symptomatic venous thromboembolism (VTE), which occurred about as often as myocardial infarction or stroke in the JUPITER study. Compared with placebo, rosuvastatin was associated with a 43% reduction (HR, 0.57; 95% CI, 0.37 to 0.86; p=0.007) in risk of VTE and no increase in bleeding [Glynn RJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELipid Disorders Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EA number of presentations highlighted new analyses from the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00239681\u0026amp;atom=%2Fspmdc%2F9%2F2%2F13.atom\u0022\u003ENCT00239681\u003C\/a\u003E) study, the results of which are expected to have a significant impact on the screening and treatment of cardiovascular disease (CVD). JUPITER was a primary preventive, prospective, randomized trial that included 17,802 men (aged \u226550 years) and women (aged \u226560 years) with no CVD or diabetes mellitus, and low-density lipoprotein (LDL) cholesterol and high-sensitivity C-reactive protein (hsCRP) levels \u0026lt;130 mg\/dL and \u22652 mg\/L, respectively. Subjects received either rosuvastatin (20 mg\/day) or placebo. The trial was stopped prematurely after a median follow-up of 1.9 years due to clear and significant treatment benefits, wherein rosuvastatin produced a 44% reduction in the primary study endpoint (cumulative incidence rate of myocardial infarction [MI], stroke, arterial revascularization, hospitalization for unstable angina, or cardiovascular death) compared with placebo (HR, 0.56; 95% CI, 0.46 to 0.69; p\u0026lt;0.00001) [Ridker PM et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ERobert Glynn, PhD, Brigham and Women\u0027s Hospital, Boston, MA, presented findings from another prespecified analysis of the JUPITER data, assessing the effect of rosuvastatin on symptomatic venous thromboembolism (VTE), which occurred about as often as MI or stroke in the JUPITER study. Compared with placebo, rosuvastatin was associated with a 43% reduction (HR, 0.57; 95% CI, 0.37 to 0.86; p=0.007) in risk of VTE and no increase in bleeding [Glynn RJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ERosuvastatin reduced the occurrence of both provoked (p=0.03) and unprovoked (p=0.09) VTE (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Although the incidence of both pulmonary embolism and DVT was reduced, DVT alone was significantly reduced (p=0.004). The benefit of rosuvastatin was consistent across patient subgroups, based on baseline variables, while VTE reduction was independent of a prior cardiovascular event. Among patients who had VTE as the first event, there was a significant 43% reduction in risk (HR, 0.57; 95% CI, 0.37 to 0.86; p=0.007), similar to the 44% reduction in risk that was associated with rosuvastatin for the prevention of a first cardiovascular event.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/13\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022JUPITER Venous Thromboembolism\u0026#x2014;Unprovoked versus Provoked.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-740553103\u0022 data-figure-caption=\u0022JUPITER Venous Thromboembolism\u0026#x2014;Unprovoked versus Provoked.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/13\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/13\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/13\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11491\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EJUPITER Venous Thromboembolism\u2014Unprovoked versus Provoked.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECopyright \u00a9 Massachusetts Medical Society 2009. All rights reserved.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EWhen questioned regarding the likely underlying mechanisms of rosuvastatin, Dr. Glynn said he believed that the most likely candidate was an anticoagulant effect, noting that statins downregulate the blood coagulation cascade through decreased tissue factor expression, leading to reduced thrombin formation, as reported by Undas et al [Undas A et al. \u003Cem\u003EArterioscler Thromb Vasc Biol\u003C\/em\u003E 2005]. \u201cWidening the treatment target to include prevention of VTE in addition to arterial thrombosis will increase the benefits of statin use,\u201d Dr. Glynn concluded.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPaul Ridker, MD, Brigham and Women\u0027s Hospital, Boston, MA, discussed results of another prespecified subanalysis that compared clinical outcomes between JUPITER trial participants according to achieved levels of LDL and hsCRP. The findings established hsCRP as a biomarker of risk for cardiovascular disease not only in people with known risk factors but also in asymptomatic individuals who previously were considered at average or even low risk for MI, stroke, or death from cardiovascular causes [Ridker PM et al. \u003Cem\u003ELancet\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIn this subanalysis (87% of full cohort), the clinical outcomes of JUPITER trial participants were evaluated according to achieved levels of LDL (\u226570 or \u0026lt;70 mg\/dL) and hsCRP (\u22652 or \u0026lt;2 mg\/L).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EAfter adjusting for baseline variables, rosuvastatin-treated subjects who achieved a reduction in LDL levels to \u0026lt;70 mg\/dL had a 55% reduction in cardiovascular events (HR, 0.45; 95% CI, 0.34 to 0.60; p\u0026lt;0.0001); those who achieved an hsCRP reduction \u0026lt;2 mg\/L had a 62% reduction in event rate (HR, 0.38; 95% CI, 0.26 to 0.56; p\u0026lt;0.0001), and those who achieved both a reduction of LDL \u0026lt;70 mg\/dL and hsCRP \u0026lt;2 mg\/L had a 65% CV event reduction (HR, 0.35; 95% CI, 0.23 to 0.54; p\u0026lt;0.0001). In individuals who achieved an LDL reduction of \u0026lt;70 mg\/dL and hsCRP reduction of \u0026lt;1 mg\/L, there was a 79% event rate reduction (HR, 0.21; 95% CI, 0.09 to 0.52; p\u0026lt;0.001). Similar effects were observed in analyses that were based on apolipoprotein (Apo) B or ApoB: ApoA ratio rather than on LDL.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Ridker pointed out that the impact of hsCRP reduction appears to be independent of LDL, because less than 2% of the variance in achieved hsCRP was explained by the variance in achieved LDL. This fits with previous study results (PROVE IT-TIMI 22 and A to Z trials) that have indicated that in patients with acute coronary ischemia who were treated with statin therapy, greater clinical benefits were achieved when hsCRP levels were reduced to below 1 to 2 mg\/L [Ridker PM et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005; Morrow DA et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2006].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EDespite these encouraging results, Dr. Ridker stressed that for patients with raised LDL or raised hsCRP, initial interventions should include dietary restrictions, exercise, and smoking cessation. However, he estimated that applying the JUPITER screening and treatment strategy to the overall US population for 5 years could prevent more than 250,000 cardiovascular disease-related events.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/2\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmkf1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmkf1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}