Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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8. •• Ridker PM, Danielson E, Fonseca FA; et al, JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008; 359(21):2195–2207.This is a large placebo-controlled trial demonstrating protection against cardiovascular events and total mortality with intensive 50% LDL-C reduction and average LDL-C levels, but with high hsCRP and baseline LDL-C of only 104 mg/dL. JUPITER appears to extend the evidence for LDL-C lowering with statins to low LDL-C with high hsCRP.

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18. • Bulugahapitiya U, Siyambalapitiya S, Sithole J, Idris I. Sherwood Forest Hospitals Foundation Trust and Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK. Is diabetes a coronary risk equivalent? Systematic review and meta-analysis. Diabet Med 2009 Feb;26(2):142–8.The Data questions diabetes as marker for increased cardiovascular risk.

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21. Sever PS, Poulter NR, Dahlof B; et al, ASCOT Investigators. The Anglo-(c Cardiac Outcomes Trial lipid lowering arm: extended observations 2 years after trial closure. Eur Heart J. 2008;29(4):499–508.

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23. • American Diabetes Association. Clinical practice recommendations—2010.Diabetes Care. 2010;33(suppl 1):S31.The latest guide for clinicians confirms that LDL-C < 100 mg/d (<2.6 mmol/L) is the primary goal of lipid management in adults with diabetes.

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25. Ridker PM and MacFadyen JG. Rosuvastatin for primary prevention among individuals with elevated high-sensitivity C-reactive protein and 5% to 105 and 10% to 20% 10-year risk: Implications of the Justification for Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) Trial for “intermediate risk.” Circulation: Cardiovascular Quality and Outcomes 2010;3:447–452.

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26. •• Genest J, McPherson R, Frohlich J, et al.: 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult – 2009 recommendations. Can J Cardiol 2009;25(10): 567–579.These are the most recent North American guidelines on lipid lowering, and they accept JUPITER as Class I evidence on benefits in the patients studied with elevated hsCRP.

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27. Green, Lee A. Cholesterol-lowering therapy for primary prevention: Still much we don’t know. Arch Intern Med 2010;170(12):1007–1008.

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28. •• Ray K.K., Seshasai S.R.K., Sever P, et al. Statins and All-Cause Mortality in High-Risk Primary Prevention: A Meta-analysis of 11 Randomized Controlled Trials Involving 65,229 Participants. Arch Intern Med 2010; 170(12):1024–1031.This is a recent large meta-analysis that challenges the linear, consistent relationship of statins and decreased cardiovascular outcomes, specifically total mortality.

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36. Mills EJ, Rachlis B, Wu P, Devereaux PJ, Arora P, Perri D. Primary prevention of cardiovascular mortality and events with statin treatments. J Am Coll Cardiol 2008;52(22):1769–1781.

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40. Boutron I, Dutton S, Ravaud, P, and Altman DG. Reporting and interpretation of randomized controlled trials with statistically nonsignificant results for primary outcomes. JAMA 2010;303(20):2058–2064.

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