Patients who have low C-reactive protein (CRP) levels, a marker of inflammation, after statin therapy have better clinical outcomes than those with higher CRP levels, regardless of the resultant level of LDL (“bad”) cholesterol, according to the multicenter PROVE IT-TIMI 22 clinical trial.
Relationships between the LDL and CRP levels after treatment with the “statin” drugs Lipitor (atorvastatin) in 80 mg/day dosage or Pravachol (pravastatin) in 40 mg/day dosage among 3,745 patients were measured, as well as the risk of recurrent myocardial infarction or death from coronary causes.
Although Lipitor was more likely than Pravachol to result in low levels of LDL cholesterol and CRP, meeting these targets was more important in determining the outcomes than was the specific therapy. Patients with LDL cholesterol levels of less than 70 mg/dl and CRP levels of less than 1 mg per liter after statin therapy had the lowest rate of recurrent events.
Strategies to lower cardiovascular risk with statins should include monitoring CRP as well as cholesterol, advise the researchers.
—New England Journal of Medicine, January 6, 2005
Clinical adviser’s note: The same issue of NEJM contains another article supporting the link between statin therapy and lower CRP levels, this time in patients already having documented coronary heart disease. The REVERSAL multicenter study concludes that for patients with coronary heart disease, the reduced rate of progression of atherosclerosis associated with intensive statin therapy, as compared to moderate statin treatment, is significantly related to greater reductions in the levels of both LDL cholesterol and CRP. As in the PROVE IT-TIMI 22 study reported above, the patients in the REVERSAL study were randomized to either Lipitor 80 mg/day or Pravachol 40 mg/day.