We should not forget that the Jupiter trial cherry picked its patients before starting: i.e. over half of those proposed were rejected, for reasons that have not been explained. Secondly, the drop out rate in the one year was 25%, which is probably a record, and makes it very hard to accept anything based on the tiny changes in risk identified (0.3%). Thirdly, there were excess diabetes cases of 2% more of patients on rosuvastatin than placebo (that is 2% absolute, not 2% relative change). Fourthly, Jupiter was set up to prove that CRP was a factor in CHD, and that rosuvastatin was an effective treatment for that, whereas the study demonstrated no connection between CHD and CRP, and in any event rosuvastain had no tangible effect on CRP levels. That's why they switched the emphasis to women, because the figures were slightly better. Fifthlv, rosuvastain has proved to have more severe side effects, especially joint pains, than the other statins, which is why in the UK it is only prescribed where other statins are not usable, and never as a first choice.

The claimed positive results from Jupiter are utterly trivial, overwhelmed by the negative health effects, and in any event the study was invaidated entirely by the drop out rate.

Do you people ever read the whole reports, and evaluate the figures? Or are you happy to limit yourselves to the drug companies increasingly desperate spin?

Another home run for Jupiter?! When the very stringent entry criteria for Jupiter are applied to the US population at large, only 4% of the US adults would qualify for the study. Not to mention the laundry list of shortcomings mentioned in the post above. How much can you learn from a study of this nature?

When is this devious and unethical deployment of clinical research going to end? Clinical Research is no longer research ... it has been conveniently been transformed into a marketing gimmick (for the pharma companies and the investigators). Trials have ceased to have the sanctity that they once did. And the proof of the pudding is the abyssmally higher rate of "Problem-Drugs" amongst new launches than those launched 20-30 years back.

To come to the point, JUPITER and all its incumbents (results included) are best left to orbit in the outer space due to little or no relevance to treatment for an individual patient. I know enough medicine to not try to find specific and separate drugs for women, separate drugs for diabetics, separate drugs for elderly, separate drugs for children (as Rosuvastatin will no doubt want us to believe!!!). The process of diabetes is sufficeintly common across patients of all profiles to warrant the same drugs ... and the same is true for dydlipidemia or heart disease or metabolic syndrome or any of the other similar hot favorites (there is, as of now, no sexual bias in pathophysiology that can be based on sound and unequivocal studies ... so the whole thing about "women" is a sorbid and unfortunate joke and a desparate attempt at justification and revenues).

As far as CRP is concerned and CHD, when will the cardiologists and the clinical researched learn about the difference between an etiological factor and a marker ... the former being a cause and the latter being an effect??!?! Without reiterating the obvious, where is the proof that CRP is a causative factor in CHD/CAD? Why are trials wasting our time in trying to establish that elevated CRP causes CAD/CHD when it is obvious that CRP is, at best, an inflammatory marker?

Let's face it. Irrespective of the medical obsessions with prescribing "contemporary" drugs based on the misguided premise that "new is better", there is currently no solid new reason to change my patients from simvastain or atorvastatin, specially in light of the, perhaps inconclusive and minimal but distinct, risks voiced in the literature. A proper risk:benefit analysis is warranted by myself in my patients before I can accept the result sof the stalwatrs.

After so many controvercies , is it really worthy to prescribe Rosuvastatin??

In one word, No. Other statins are non-controversial with generic shortcomings, while Rosuvastatin's acsendancy into the clinical world is riddled with controversies since early 2000's without any hint at resolution... something that prompts me to tread with caution and thought.

As a primary care physician with active involvement in cardio-diabetic and chronic disease management, I consider it my responsibility to buffer my patients from the commercial interests of various healthcare partners including pharma companies, corporate hospitals and their doctors. I understand the kinetics of clinical research and statistical jugglery. I understand the equations that exist in funding of clinical trials and that mere disclosures by investigators means nothing.

Therefore, in my perhaps insignificant opinion, we physicians shoudl exercise our own grey cells in evaluating the clinical trials irrespective of which journal has published it or who the principal investigator is. If it makes clinical sense, adopt it ... if your patients suffer, reject it.

Amen! Amen! Amen! to all Dr. Amit V's comment. As a clinical researcher I am trying to show the "difference between an etiological factor and a marker of the former" and have been shot down time and again by mighty machinery of big institution and big names. I am preparing another attempt to show the world that significant results do not necessarily mean clinical benefit.

Salami slicing of data is in the curriculum of some medical schools. I learned that "slice it as thin as possible, for more papers"; one for "elderly" one for "women" "one for sneaker wearer" "restricted to vegetarians" etc. 

 The only thing I may differ from  Amit \'s view is that post menopausal women may have more problems with carbohydrate metabolism,  diabetes and thus CVD. I am not an endocrinologist but as a biologist I have a hunch that there may be some link between estrogen and glucose metabolism. Initially, I defended JUPITER group for taking Pharma money but now  I , too, want to scream as Amit said : "When is this devious and unethical deployment of clinical research going to end?"

Thank you Kimchi for your comments and immensely valuable and relevant insights. I am particularly enthralled by two of your philosophies (a) "difference between an etiological factor and a marker of the former", and (b) "significant results do not necessarily mean clinical benefit", both being of ciritical value to a good physician. I wish you all the best with both crusades!!!

With regard to women and their cloak of estrogen, I am in total agreement with you. Perhaps I was not clear enough in my earlier comments. I know, from the published literature, about the various reasons that estrogens can directly or indirectly afford protection from cardiovascular events. However, the extent to which role of post-menopausal deprivation of estrogen plays a role in CV events and, more importantly, the qualitative evaluation of this pathophysiology. Thus, my contention is that if one is trying to seek clarifications about the benefits in women then the trial needs to be designed in a different way with proper screening for the hormonal status since perimenopausal is not the same as menopausal which is not the same as postmenopausal period. And. moreover, the entire duration of the perimenopausal + menopausal period AFTER which the woman is at real risk, can be a real long period of time that is impossible to factor into a clinical trial. Thus screening to ensure postmenopausal status is critical ... and then should begin the epidemiological or interventional initiative. Anyway, ... I better stop before this blog become boring for the readers!!!

Of Course I agree with all has been said. Difference between risk factor and risk marker should be taught earlier at school. And also difference between absolute and relative risk. The lowest is the absolute change, the easiest is to find a huge relative change : example  Have a 100% increasing risk to win on lottery by buying a second ticket. 

When including healthy patients, in a trial like Jupiter; the absolute CV risk expected is low, The ratio between two small numbers  may be high or "significative" if p<0,05, it is not significant for me because denominators vanished.   

I feel  your pain as "physician with active involvement in cardio-diabetic and chronic disease management, ..." when reserch community blasts all the horns and trumpets of media blitz using "devious and unethical trial results ". as you said. Yes, definitely your grey matter should guide your clinical decision AND That Is NOT Insignificant!

I wrote to a big journal that randomized trials are mutivariate model that implicitly adjusted all the covariates but individual patients may not have exactly the same profile. Thus, Primary care Physician should determine the appropriateness of any statin adminstration, not just depending on CRP level to decide to statin or not to statin.

Guess what? It was shot down, saying that "randomized trial is not multivariate model adjusting...." but  they said "by randomization, all confounders were balanced between the groups. "  What's the diff? "balanced" or "implicitly adjusted"? Using this kind of semantic, my arguement was blocked. So continue to use your grey matter.

I totally agree with jabeau "it is not significant for me because denominators vanished".  Listen to this. I also wrote a very similar observation in the aforementioned article that CRP >2mg goup had 72 events while in the same group with high CRP, 4233 did not have events. But for the relative risk, they compared 72 to 31 (in the CRP low group). Whoa! halve the risk!!!

I am mortified by this blanket endorsement from Dr. Goldhaber.  When are physicians in this country going to stop being shills for Big Pharma?  The notion of statins for primary prevention is not only ridiculous, it is dangerous.  Many of the comments noted that the JUPITER trial was clearly manipulated.  It certainly doesn't take a rocket scientist to figure that out.  What amazes me is that we continue to ignore the epidemiologic evidence from other countries where Mediterranean diet, fish consumption, and lifestyle choices have had a profound and safe impact on the prevention of cardiovascular disease in those populations.  Unfortunately for Pharma, you can't write a prescription for a healthy lifestyle and sensible nutrition.

I agree fully with the comments above from Dr Michael Gross. I personally view the JUPITER marketing campaign as pure sales. I do not accept it as a valid study. At least thats my consumer view point.

I found conflicts of interest all over the JUPITER marketing campaign. The absolute risk reductions were tiny fractions of a fraction. The actual hard number NNT scores were highly elevated, and in the end they published an NNT of 25.  Uh huh, sure, right.

I'm just a regular guy with no medical education. ( 9th grade) I don't believe in Santa Clause or the Tooth Fairy, which puzzles me as to why the physician in the video above, a man with great education, would be so absorbed by the JUPITER "Study."

I appreciate being given the opportunity to share my consumer viewpoint. I honestly see JUPITER as nothing more than promotion of commercial interests.