Bill

http://cardiology.jwatch.org/cgi/content/full/2005/225/1?q=etoc
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           Summary and Comment

     Prognostic Importance of CRP for Statin Users
     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

     Source

     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.
     [Original article][Medline abstract][Download citation]

     Ehrenstein MR et al. Statins for atherosclerosis -- As good as it gets?
N Engl J Med 2005 Jan 6; 352:73-5.
     [Original article][Medline abstract][Download citation]

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