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Prognostic Importance of CRP for Statin Users
C-reactive protein and LDL-cholesterol reductions achieved during statin therapy each were independently associated with improved outcomes.
Statins clearly lower LDL-cholesterol levels and, thereby, reduce cardiovascular risk. Some evidence suggests that statins' anti-inflammatory properties also play a role in this risk reduction. To test that possibility, researchers analyzed levels of C-reactive protein (CRP), an inflammatory marker, among 3745 acute coronary syndrome (ACS) patients (mean age, 58; 22% women) enrolled in the PROVE-IT trial. In PROVE-IT, subjects randomized to receive 80-mg atorvastatin experienced significantly fewer cardiovascular events during 2 years of follow-up than did those randomized to 40-mg pravastatin (Journal Watch Cardiology Apr 16 2004). The current study was funded partly by pravastatin's manufacturer.
Reductions in LDL levels correlated weakly with reductions in CRP levels, yet the achieved levels of both markers were significantly and independently associated with reduced age-adjusted rates of recurrent cardiovascular events. Among patients who achieved LDL levels <70 mg/dL, event rates were lower among patients who achieved CRP levels <2 mg/L than among those with CRP levels 
2 mg/L (2.4 vs. 3.1 events per 100 person-years). Among patients who achieved LDL levels 70 mg/dL, a similar advantage of achieved CRP <2 mg/L was evident (3.2 vs. 4.6 events per 100 person-years). After adjustment for achieved levels of LDL and CRP, neither statin (pravastatin or atorvastatin) more effectively prevented adverse events than the other.
Comment: CRP and LDL reductions achieved during statin therapy each were independently associated with improved outcomes. The next question to address is whether a treatment strategy targeted at both LDL and CRP levels would yield better outcomes than one targeted only at LDL.
— Harlan M. Krumholz, MD, SM
Published in Journal Watch Cardiology February 25, 2005
Citation(s):
Ridker PM et al. for the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes after statin therapy. N Engl J Med 2005 Jan 6; 352:20-8.
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- Medline abstract (Free)
Ehrenstein MR et al. Statins for atherosclerosis -- As good as it gets? N Engl J Med 2005 Jan 6; 352:73-5.
- Original article (Subscription may be required)
- Medline abstract (Free)