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)?


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.


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.


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.


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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