A study linking residual inflammation with adverse cardiovascular events in patients receiving statins could indicate a need for “combined use of aggressive lipid-lowering and inflammation-inhibiting therapies … to further reduce atherosclerotic risk.” The authors conclude, “Inflammation assessed by [high-sensitivity C-reactive protein (CRP)] was a stronger predictor for risk of future cardiovascular events and death than cholesterol assessed by [LDL cholesterol (LDLC)]. These data have implications for the selection of adjunctive treatments beyond statin therapy and suggest that combined use of aggressive lipid-lowering and inflammation-inhibiting therapies might be needed to further reduce atherosclerotic risk.”
Data from 3 studies of contemporary statins in patients with or at high risk of atherosclerotic disease were analyzed for information on CRP and LDLC tests, major adverse cardiovascular events, cardiovascular death, and all-cause death. Based on hazard ratios (HR) for cardiovascular events and deaths, the investigators found these results: “31,245 patients were included in the analysis from the PROMINENT (n = 9,988), REDUCE-IT (n = 8,179), and STRENGTH (n = 13,078) trials. The observed ranges for baseline high-sensitivity CRP and LDLC, and the relationships of each biomarker to subsequent cardiovascular event rates, were almost identical in the three trials. Residual inflammatory risk was significantly associated with incident major adverse cardiovascular events (highest high-sensitivity CRP quartile vs lowest high-sensitivity CRP quartile, adjusted HR 1.31, 95% CI 1.20–1.43; P <0.0001), cardiovascular mortality (2.68, 2.22–3.23; P <0.0001), and all-cause mortality (2.42, 2.12–2.77; P <0.0001). By contrast, the relationship of residual cholesterol risk was neutral for major adverse cardiovascular events (highest LDLC quartile vs lowest LDLC quartile, adjusted HR 1.07, 95% CI 0.98–1.17; P = 0.11), and of low magnitude for cardiovascular death (1.27, 1.07–1.50; P = 0.0086) and all-cause death (1.16, 1.03–1.32; P = 0.025).”