Measurement of C-Reactive Protein for the Targeting of Statin Therapy in the Primary Prevention of Acute Coronary Events
Paul M. Ridker, M.D., M.P.H., Nader Rifai, Ph.D., Michael Clearfield, D.O., John R. Downs, M.D., Stephen E. Weis, D.O., J. Shawn Miles, M.D., Antonio M. Gotto, Jr., M.D., D.Phil., for the Air Force/Texas Coronary Atherosclerosis Prevention Study Investigators
Background Elevated levels of C-reactive protein, even in theabsence of hyperlipidemia, are associated with an increasedrisk of coronary events. Statin therapy reduces the level ofC-reactive protein independently of its effect on lipid levels.We hypothesized that statins might prevent coronary events inpersons with elevated C-reactive protein levels who did nothave overt hyperlipidemia.
Methods The level of C-reactive protein was measured at baseline and after one year in 5742 participants in a five-yearrandomized trial of lovastatin for the primary prevention ofacute coronary events.
Results The rates of coronary events increased significantlywith increases in the base-line levels of C-reactive protein.Lovastatin therapy reduced the C-reactive protein level by 14.8percent (P<0.001), an effect not explained by lovastatin-inducedchanges in the lipid profile. As expected, lovastatin was effectivein preventing coronary events in participants whose base-lineratio of total cholesterol to high-density lipoprotein (HDL)cholesterol was higher than the median ratio, regardless ofthe level of C-reactive protein (number needed to treat forfive years to prevent 1 event, 47; P=0.005). However, lovastatinwas also effective among those with a ratio of total to HDLcholesterol that was lower than the median and a C-reactiveprotein level higher than the median (number needed to treat,43; P=0.02). In contrast, lovastatin was ineffective among participantswith a ratio of total to HDL cholesterol and a C-reactive proteinlevel that were both lower than the median (number needed totreat, 983; P=0.87).
Conclusions Statin therapy may be effective in the primary preventionof coronary events among persons with relatively low lipid levelsbut with elevated levels of C-reactive protein.
Source Information
From the Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., N.R., J.S.M.); the University of North Texas Health Science Center, Fort Worth (M.C., S.E.W.); Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Tex. (J.R.D.); and Weill Medical College of Cornell University, New York (A.M.G.).
Address reprint requests to Dr. Ridker at the Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, 900 Commonwealth Ave. E., Boston, MA 02215, or at pridker{at}partners.org.
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