Prevention and Rehabilitation Race, ethnicity, and the efficacy of rosuvastatin in primary prevention: The Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial Michelle A. Albert, MD, MPH, a,b Robert J. Glynn, ScD, PhD, b Francisco A. H. Fonseca, MD, c Alberto J. Lorenzatti, MD, d Keith C. Ferdinand, MD, e Jean G. MacFadyen, BA, b and Paul M Ridker, MD, MPH a,b Boston, MA; Sao Paulo, Brazil; Cordoba, Argentina; and Atlanta, GA Objectives The aim of this study was to evaluate the effect of statin treatment in primary prevention of cardiovascular events in different race/ethnic groups. Background Clinical trial evidence about the efficacy of statins in the primary prevention of cardiovascular events among nonwhites is uncertain. Methods JUPITER trial, a randomized, double-blind, placebo-controlled evaluation of rosuvastatin 20 mg in the primary prevention of myocardial infarction (MI), stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death included 12,683 whites and 5,117 nonwhites with low-density lipoprotein levels b130 mg/dL and high-sensitivity C-reactive protein levels ≥2.0 mg/L. Results Random allocation to rosuvastatin resulted in a 45% reduction in the primary end point among whites (hazard ratio [HR] 0.55, 95% CI 0.43-0.69) and a 37% reduction among nonwhites (HR 0.63, 95% CI 0.41-0.99). Blacks (HR 0.65, 95% CI 0.35-1.22) and Hispanics (HR 0.58, 95% CI 0.25-1.39) had similar risk reductions. Among nonwhites in the placebo group, the stroke rate exceeded the MI rate (0.44 vs 0.20 per 100 person-years); an opposite pattern was observed among whites (0.31 vs 0.42 per 100 person-years). Nonwhites had higher death rates than whites (2.25 vs 0.93 per 100 person- years); however, all-cause mortality was similar at 20% with rosuvastatin treatment in both participant groups. Conclusions When used in primary prevention among individuals with low-density lipoprotein b130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L, rosuvastatin significantly reduced first MI, stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death among whites and nonwhites. (Am Heart J 2011;162:106-114.e2.) Although statin therapy has proven highly effective in the primary prevention of cardiovascular events in white populations, 1 clinical trial data among nonwhites are scarce. For example, the WOSCOPS of 6,595 men and the AFCAPS/TEXCAPS of 6,605 participants together included b1,000 blacks and 500 Hispanics. 2,3 Conse- quently, it remains uncertain whether statins are similarly beneficial in primary prevention in nonwhite popula- tions. JUPITER trial 4 was a randomized, double-blind, placebo-controlled primary prevention trial that investi- gated whether individuals with average low-density lipoprotein (LDL-C) but elevated high-sensitivity C-reac- tive protein (CRP) (hsCRP) levels would benefit from statin therapy. As previously reported, 4,5 among 17,802 participants with LDL-C b130 mg/dL and hsCRP ≥2 mg/L, rosuvastatin allocation was associated with a 54% reduction in myocardial infarction (MI) (P = .0002), a 48% reduction in stroke (P = .002), a 46% reduction in need for bypass surgery or angioplasty (P b .001), a 43% reduction in venous thromboembolism (P = .007), and a 20% reduction in all-cause mortality (P = .02) over a median follow-up of 1.9 years. Because JUPITER enrolled From the a Division of Cardiovascular Diseases, Center for Cardiovascular Disease Prevention, Donald W. Reynolds Center for Cardiovascular Disease Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, b Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, c Universidade Federal de Sao Paulo, Disciplina de Cardiologia, Setor de Lipides, Aterosclerose e Biologia Vascular, Sao Paulo, Brazil, d Hospital Cordoba, Cordoba, Argentina, and e Emory University Division of Cardiology, Atlanta, GA. RCT reg # NCT00239681. Submitted November 22, 2010; accepted March 21, 2011. Reprint requests: Michelle A. Albert, MD, MPH, Division of Cardiovascular Disease Prevention, 15 Francis Street, Boston, MA 02215. E-mail: maalbert@partners.org 0002-8703/$ - see front matter © 2011, Mosby, Inc. All rights reserved. doi:10.1016/j.ahj.2011.03.032