High-Sensitivity C-Reactive Protein, Statin Therapy, and Risks of Atrial Fibrillation: An Exploratory Analysis of the JUPITER Trial

Study Questions:

Does reducing inflammation as indicated by high-sensitivity C-reactive protein (hs-CRP) with statins reduce the risk of atrial fibrillation (AF)?

Methods:

Data from the JUPITER (Justification for the Use of Stains in Prevention: An Intervention Trial Evaluating Rosuvastatin) trial were used for the current analysis. Men and women were randomized to either rosuvastatin 20 mg daily or placebo. Entry criteria included a low-density lipoprotein cholesterol of ≤130 mg/dl and hs-CRP of ≥2 mg/L. The primary outcome of interest was incident AF determined from treatment-blind adverse event reports.

Results:

A total of 17,120 participants without prior history of arrhythmia were included in this analysis. The median age of the cohort was 66 years, 38% were women, and 57% had a blood pressure >140/90 mm Hg or were taking antihypertensive medications. The median body mass index was in the overweight category (28.4 kg/m2), and the median hs-CRP was 4.3 mg/L. Each increasing tertile of baseline hs-CRP was associated with a 36% increase in the risk of developing AF (95% confidence interval, 1.16-1.60; p for trend < 0.01). The group randomized to rosuvastatin had a 27% lower risk of developing AF during the trial period compared to those randomized to placebo (incidence rate 0.78 vs. 0.56/100 person-years; hazard ratio, 0.73; 95% CI, 0.56-0.94; p = 0.01). After excluding subjects who had developed a major cardiovascular event prior to development of AF, the results were similar.

Conclusions:

The authors concluded that among participants of the JUPITER trial, inflammation reflected as increased hs-CRP was associated with an increased risk of incident AF, and random allocation to rosuvastatin significantly reduced that risk.

Perspective:

Given the projected increase in AF over the next several decades, these findings support the need to understand risk factors associated with development of AF.

Clinical Topics: Dyslipidemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Fluorobenzenes, Inflammation, Coloring Agents, Overweight, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Pyrimidines, Blood Pressure, Risk Factors, Cholesterol, C-Reactive Protein, Body Mass Index, Biological Markers, Confidence Intervals, Sulfonamides


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