Journal
EUROPEAN HEART JOURNAL
Volume 33, Issue 4, Pages 486-494Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehr262
Keywords
C-reactive protein; Atorvastatin; ASCOT
Categories
Funding
- Biomedical Research Centre
- BHF-Research Centre
- BHF [FS/10/005/28147]
- Pfizer
- Merck Co.
- AstraZeneca
- NIHR
- British Heart Foundation [FS/10/005/28147] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0508-10116] Funding Source: researchfish
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We tested whether on-statin C-reactive protein is associated with cardiovascular (CV) outcome in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). ASCOT randomized a subset of 4853 patients with total cholesterol 6.5 mmol/L (250 mg/dL) to atorvastatin or placebo. In a casecontrol 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. Among these hypertensive patients selected on the basis of traditional 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.
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