Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Prev Med. 2011 Feb;52(2):159-63. doi: 10.1016/j.ypmed.2010.11.018. Epub 2010 Dec 3.
To evaluate the public health impact of statin prescribing strategies based on the Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin Study (JUPITER).
We studied 2268 adults aged 35-75 without cardiovascular disease in a population-based study in Switzerland in 2003-2006. We assessed the eligibility for statins according to the Adult Treatment Panel III (ATPIII) guidelines, and by adding "strict" (hs-CRP≥2.0 mg/L and LDL-cholesterol <3.4 mmol/L), and "extended" (hs-CRP≥2.0 mg/L alone) JUPITER-like criteria. We estimated the proportion of CHD deaths potentially prevented over 10 years in the Swiss population.
Fifteen percent were already taking statins, 42% were eligible by ATPIII guidelines, 53% by adding "strict," and 62% by adding "extended" criteria, with a total of 19% newly eligible. The number needed to treat with statins to avoid one CHD death over 10 years was 38 for ATPIII, 84 for "strict" and 92 for "extended" JUPITER-like criteria. ATPIII would prevent 17% of CHD deaths, compared with 20% for ATPIII+"strict" and 23% for ATPIII + "extended" criteria (+6%).
Implementing JUPITER-like strategies would make statin prescribing for primary prevention more common and less efficient than it is with current guidelines.
评估基于他汀类药物在一级预防中的应用理由：评估罗苏伐他汀研究（JUPITER）的干预试验的他汀类药物处方策略对公共卫生的影响。
我们在 2003-2006 年瑞士的一项基于人群的研究中研究了 2268 名年龄在 35-75 岁之间无心血管疾病的成年人。我们根据成人治疗小组 III（ATPIII）指南以及添加“严格”（hs-CRP≥2.0mg/L 和 LDL-胆固醇<3.4mmol/L）和“扩展”（hs-CRP≥2.0mg/L 单独）JUPITER 样标准来评估他汀类药物的适用性。我们估计了在瑞士人群中，10 年内潜在预防 CHD 死亡的比例。
15%的人已经服用了他汀类药物，42%的人符合 ATPIII 指南的标准，53%的人符合添加“严格”标准，62%的人符合添加“扩展”标准，总共增加了 19%的新符合标准者。10 年内每治疗 38 人以预防一例 CHD 死亡的他汀类药物治疗的人数分别为 ATPIII 为 38、“严格”为 84 和“扩展”为 92（JUPITER 样标准为 92）。ATPIII 将预防 17%的 CHD 死亡，而 ATPIII+“严格”将预防 20%，ATPIII+“扩展”将预防 23%（增加 6%）。
实施类似 JUPITER 的策略将使他汀类药物在一级预防中的应用更加普遍，但效率低于当前指南。
