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Evaluation of C-reactive protein prior to and on-treatment as a predictor of benefit from atorvastatin: observations from the Anglo-Scandinavian Cardiac Outcomes Trial
European Heart Journal, 07/29/2011
Clinical Article
Sever PS et al. – Among these hypertensive patients selected on the basis of traditional cardiovascular (CV) risk factors, C–reactive protein did not usefully improve the prediction of CV events and, critically, reduction in C–reactive protein associated with statin therapy was not a predictor of CV outcome alone or in combination with LDL–c.
Methods- ASCOT randomized a subset of 4853 patients with total cholesterol ≤6.5 mmol/L (250 mg/dL) to atorvastatin or placebo.
- In a case–control study during 5.5–year follow–up, 485 CV cases were age– and sex–matched with 1367 controls.
- Baseline LDL–cholesterol (LDL–c) and log–transformed C–reactive protein predicted CV events [odds ratio (OR) per 1 standard deviation (SD) 1.31 (95% confidence interval {CI}: 1.10, 1.56), P = 0.002 and OR 1.19 (1.05, 1.34), P = 0.006, respectively].
- Including baseline C–reactive protein into a Framingham risk model very modestly improved risk prediction.
- Baseline C–reactive protein did not indicate the magnitude of the atorvastatin effect on CV outcome (P = 0.54).
- At 6 months, atorvastatin reduced median LDL–c by 40.3% and median C–reactive protein by 27.4%.
- In those randomized to atorvastatin, lower on–treatment LDL–c at 6 months was associated with a significant reduction in subsequent CV events [OR 0.41 (0.22, 0.75), P = 0.004] comparing those above and below the median (2.1 mmol/L).
- In contrast, C–reactive protein below the median (1.83 mg/L) compared with C–reactive protein above the median was not associated with a significant reduction in CV events [OR 0.86 (0.49, 1.51), P = 0.60].
- Consequently, addition of on–treatment C–reactive protein to LDL–c did not improve prediction of statin efficacy.
