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Inflammation vs. Cholesterol for Predicting Cardiovascular Events During Statin Therapy

High-sensitivity C-reactive protein (CRP) is a stronger predictor of cardiovascular risk and death than LDL cholesterol levels in patients taking contemporary statins, investigators conclude based on data from 3 multinational trials. “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,” the authors conclude.

Participants in the PROMINENT, REDUCE-IT, or STRENGTH trials were on statin therapy for atherosclerotic disease or high risk of this disease. Quartiles of increasing baseline high-sensitivity CRP and baseline LDL-C were used to predict future major adverse cardiovascular events, cardiovascular death, and all-cause death, with 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).”

Source: Lancet