C-Reactive Protein Levels and Outcomes after Statin Therapy

• Published in: The New England journal of medicine Vol. 352; no. 1; pp. 20 - 28
• Main Authors: Ridker, Paul M, Cannon, Christopher P, Morrow, David, Rifai, Nader, Rose, Lynda M, McCabe, Carolyn H, Pfeffer, Marc A, Braunwald, Eugene
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 06.01.2005
• Subjects: Anticholesteremic Agents - administration & dosage; Anticholesteremic Agents - pharmacology; Anticholesteremic Agents - therapeutic use; Atorvastatin Calcium; Biological and medical sciences; Biomarkers - blood; C-Reactive Protein - drug effects; C-Reactive Protein - metabolism; Cardiovascular disease; Cholesterol; Cholesterol, LDL - blood; Cholesterol, LDL - drug effects; Coronary Disease - blood; Coronary Disease - mortality; Coronary Disease - prevention & control; Female; Fluoroquinolones - therapeutic use; General aspects; Heart attacks; Heptanoic Acids - administration & dosage; Heptanoic Acids - pharmacology; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - pharmacology; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Incidence; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - drug therapy; Myocardial Infarction - prevention & control; Pravastatin - administration & dosage; Pravastatin - pharmacology; Pravastatin - therapeutic use; Proportional Hazards Models; Pyrroles - administration & dosage; Pyrroles - pharmacology; Pyrroles - therapeutic use; Risk Factors; Secondary Prevention; Statins; Medicine; Acute phase protein; Prognosis; Treatment; Evolution; Statin derivative; C reactive protein
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa042378

Statin therapy lowers not only low-density lipoprotein (LDL) cholesterol levels, but also levels of C-reactive protein (CRP), a marker of inflammation. This study examined the independent effects of decreasing LDL cholesterol and CRP levels on subsequent coronary risk in patients with acute coronary syndromes who were receiving pravastatin or atorvastatin. Lowering CRP levels reduced coronary risk irrespective of the extent of LDL cholesterol lowering. Patients with the lowest risk had the lowest levels of both LDL cholesterol and CRP after 30 days of statin therapy. This study examined the independent effects of decreasing LDL cholesterol and CRP levels on subsequent coronary risk in patients with acute coronary syndromes who were receiving statin therapy. Statin therapy lowers the risk of cardiovascular events by reducing plasma cholesterol levels, and practice guidelines for patients with known cardiovascular disease emphasize the importance of reaching target goals for low-density lipoprotein (LDL) cholesterol. 1 However, we have shown that statin therapy results in a greater clinical benefit when levels of the inflammatory biomarker C-reactive protein (CRP) are elevated 2 , 3 and that statins lower CRP levels in a manner largely independent of LDL cholesterol levels. 3 – 6 These findings, along with basic laboratory evidence, have led to the hypothesis that, in addition to being potent lipid-lowering agents, statins may also have antiinflammatory . . .