SynthesisCirculation2010

Statins for the primary prevention of cardiovascular events in women with elevated high-sensitivity C-reactive protein or dyslipidemia: results from the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and meta-analysis of women from primary prevention trials.

Samia Mora, Robert J Glynn, Judith Hsia, Jean G MacFadyen, Jacques Genest, Paul M Ridker

2 registry-linked trialsOpen access · greenAbstract readComparative StudyMeta-AnalysisMulticenter Study
In one paragraph

Synthesis in Circulation, 2010. The graph read 2 numbers from its abstract, feeding 1 cell of the map: it finds no clear difference in 1. It is linked to 2 registered trials, which are not on this map. Cited by 112 papers, 12 of them syntheses that pooled it.

2numbers the graph read from it
1cell of the map it votes in
112citing papers in PubMed, 12 pooled it
38.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
0.51 · no effect
All-cause mortalityfavours the treatment · against placebo · dyslipidemia, ascvdfeeds one cell of the map
RR 0.630.49 to 0.82P<0.001
Meta-analysis of 13 154 women (240 CVD events; 216 total deaths) from exclusively primary prevention trials found a significant reduction in primary CVD events with statins by a third (relative risk, 0.63; 95% confidence interval, 0.49 to 0.82; P<0.001; P for heterogeneity=0.56) with a smaller nonsignificant effect on total mortality (relative risk, 0.78; 95% confidence interval, 0.53 to 1.15; P=0.21; P for heterogeneity=0.20).
All-cause mortalityno clear difference · against placebo · dyslipidemia, ascvdfeeds one cell of the map
RR 0.780.53 to 1.15P=0.21
Meta-analysis of 13 154 women (240 CVD events; 216 total deaths) from exclusively primary prevention trials found a significant reduction in primary CVD events with statins by a third (relative risk, 0.63; 95% confidence interval, 0.49 to 0.82; P<0.001; P for heterogeneity=0.56) with a smaller nonsignificant effect on total mortality (relative risk, 0.78; 95% confidence interval, 0.53 to 1.15; P=0.21; P for heterogeneity=0.20).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×all-cause mortality

InconclusiveOpen on the map →What to test next →

13 readable studies in this cell: 3 favour the treatment, 8 find no difference, 2 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT023442907,769 enrolled · 2015
HR 0.880.70 to 1.12
HR 1.010.91 to 1.11
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
RR 0.990.89 to 1.11

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03007524 phase4unknown statusstarted 2016, after this paper: background citation

A Randomized Comparison of Low-dose Versus High-dose Rosuvastatin on Optical Coherence Tomography Based Early Vascular Healing for Patients With Acute Coronary Syndrome

Ran2016Enrolled80Registered outcomes25Posted comparisons0ConditionsAcute Coronary SyndromeArmsHigh dose Rosuvastatin, Low dose Rosuvastatin
Open the trial in the graph
NCT00239681 phase3terminatednot on this map

A Randomized, Double-Blind, Placebo Controlled, Multicenter, Phase 3 Study of Rosuvastatin (CRESTOR®) 20 mg in the Prevention of Cardiovascular Events Among Subjects With Low Levels of Low Density Lipoprotein(LDL) Cholesterol & Elevated Levels of C-Reactive Protein

TypeinterventionalSponsorAstraZenecaRan2003 to 2008Enrolled17,802ConditionsElevated High-sensitivity C-Reactive Protein (hsCRP)ArmsRosuvastatin, Placebo
5 · Its place in the literature

Who cites it

112 citing papers in PubMed, 12 syntheses or guidelines pooled it, 325 citations in OpenAlex.

  1. Statins for the primary prevention of venous thromboembolism.The Cochrane database of systematic reviews · 2024
    Pooled it
  2. Pooled it
  3. Pooled it
  4. Guideline
  5. Guideline
  6. Pooled it
  7. Statins for primary prevention of venous thromboembolism.The Cochrane database of systematic reviews · 2014
    Pooled it
  8. Pooled it
  9. Pooled it
  10. Statins for the primary prevention of cardiovascular disease.The Cochrane database of systematic reviews · 2013 · on this map
    Pooled it
  11. Pooled it
  12. Pooled it
  13. Trial
  14. Benefit of intensive statin therapy in women: results from PROVE IT-TIMI 22.Circulation. Cardiovascular quality and outcomes · 2011
    Trial
  15. Review
  16. Review
  17. Article
  18. Article
  19. Are statin side effects dependent on sex? A narrative review.Przeglad menopauzalny = Menopause review · 2025
    Review
  20. Cardiovascular Disease Risk in Women with Menopause.Journal of clinical medicine · 2025
    Review

52 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Samia MoraCenter for Cardiovascular Disease Prevention, Divisions of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. smora@partners.org
Robert J Glynn
Judith Hsia
Jean G MacFadyen
Jacques Genest
Paul M Ridker
AstraZeneca (Brazil) · BR

Funding

Novel Lipoproteins, Cardiometabolic Risk, and Statin TherapyK08HL094375 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI MORA, SAMIA · 2009 to 2012
$549k
NHLBI NIH HHS K08 HL094375
8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundStatin therapy in women without cardiovascular disease (CVD) is controversial, given the insufficient evidence of benefit. We analyzed sex-specific outcomes in the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and synthesized the results with prior trials. METHODS AND

resultsJUPITER participants included 6801 women > or =60 years of age and 11 001 men > or =50 years of age with high-sensitivity C-reactive protein > or =2 mg/L and low-density lipoprotein cholesterol <130 mg/dL randomized to rosuvastatin versus placebo. Meta-analysis studies were randomized placebo-controlled statin trials with predominantly or exclusively primary prevention in women and sex-specific outcomes (20 147 women; >276 CVD events; mean age, 63 to 69 years). Absolute CVD rates (per 100 person-years) in JUPITER women for rosuvastatin and placebo (0.57 and 1.04, respectively) were lower than for men (0.88 and 1.54, respectively), with similar relative risk reduction in women (hazard ratio, 0.54; 95% confidence interval, 0.37 to 0.80; P=0.002) and men (hazard ratio, 0.58; 95% confidence interval, 0.45 to 0.73; P<0.001). In women, there was significant reduction in revascularization/unstable angina and nonsignificant reductions in other components of the primary end point. Meta-analysis of 13 154 women (240 CVD events; 216 total deaths) from exclusively primary prevention trials found a significant reduction in primary CVD events with statins by a third (relative risk, 0.63; 95% confidence interval, 0.49 to 0.82; P<0.001; P for heterogeneity=0.56) with a smaller nonsignificant effect on total mortality (relative risk, 0.78; 95% confidence interval, 0.53 to 1.15; P=0.21; P for heterogeneity=0.20). Similar results were obtained for trials that were predominantly but not exclusively primary prevention.

conclusionsJUPITER demonstrated that in primary prevention rosuvastatin reduced CVD events in women with a relative risk reduction similar to that in men, a finding supported by meta-analysis of primary prevention statin trials. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239681.

Indexed as

AgedCholesterol, LDLComorbidityC-Reactive ProteinDouble-Blind MethodDyslipidemiasEarly Termination of Clinical TrialsFemaleFluorobenzenesFollow-Up StudiesHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedMuscular DiseasesMyocardial IschemiaCholesterol, LDLC-Reactive ProteinFluorobenzenesHydroxymethylglutaryl-CoA Reductase InhibitorsPyrimidinesRosuvastatin CalciumSulfonamides

Identifiers

PMID20176986
PMCPMC4439924
OpenAlexW2170127099

What Socratic holds

Texttitle and abstract
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.