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Evaluation of C-reactive protein before and on-treatment as a predictor of benefit of atorvastatin: a cohort analysis from the Anglo-Scandinavian Cardiac Outcomes Trial lipid-lowering arm.
J Am Coll Cardiol. 2013 Aug 20; 62(8):717-29.JACC

Abstract

OBJECTIVES

The aim of this study was to determine whether baseline and on-statin C-reactive protein (CRP) are independent predictors of cardiovascular (CV) outcome beyond low-density lipoprotein cholesterol (LDL-C).

BACKGROUND

Use of CRP as a predictor of statin treatment remains controversial.

METHODS

We investigated the relationship of baseline and on-treatment CRP with subsequent CV events in Cox models using a subset of white subjects with no history of CV disease from the UK ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial).

RESULTS

During 5.5 years of follow-up, a total of 488 subjects experienced a CV event. CV risk increased with baseline CRP (hazard ratio [HR] per 1 SD: 1.21; 95% confidence interval [CI]: 1.09 to 1.33) in an adjusted model. In ASCOT Lipid-Lowering Arm, the relative statin effect in preventing CV events did not differ according to tertiles of baseline CRP (p = 0.69). After 6 months of atorvastatin therapy, the median LDL-C and CRP were reduced by 38.7% and 25.8%, respectively. Those who achieved LDL-C below the median had a reduced CV risk (HR: 0.58; 95% CI: 0.34 to 0.97) compared with those who did not. In contrast, those who achieved a CRP level below the median did not have a reduced risk of CV events (HR: 0.95; 95% CI: 0.59 to 1.55). Among those who achieved LDL-C below the median, there was no difference in CV risk whether they also achieved a CRP level below (HR: 0.55; 95% CI: 0.30 to 1.02) or above the median (HR: 0.56; 95% CI: 0.30 to 1.03).

CONCLUSIONS

In these primary prevention patients, although baseline CRP independently predicted CV event risk, the achieved CRP level on while statin therapy did not predict CV events, either alone or in combination with LDL-C.

Authors+Show Affiliations

International Centre for Circulatory Health, National Heart & Lung Institute, Imperial College London, United Kingdom. p.sever@imperial.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23948514

Citation

Sever, Peter S., et al. "Evaluation of C-reactive Protein Before and On-treatment as a Predictor of Benefit of Atorvastatin: a Cohort Analysis From the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-lowering Arm." Journal of the American College of Cardiology, vol. 62, no. 8, 2013, pp. 717-29.
Sever PS, Poulter NR, Chang CL, et al. Evaluation of C-reactive protein before and on-treatment as a predictor of benefit of atorvastatin: a cohort analysis from the Anglo-Scandinavian Cardiac Outcomes Trial lipid-lowering arm. J Am Coll Cardiol. 2013;62(8):717-29.
Sever, P. S., Poulter, N. R., Chang, C. L., Thom, S. A., Hughes, A. D., Welsh, P., & Sattar, N. (2013). Evaluation of C-reactive protein before and on-treatment as a predictor of benefit of atorvastatin: a cohort analysis from the Anglo-Scandinavian Cardiac Outcomes Trial lipid-lowering arm. Journal of the American College of Cardiology, 62(8), 717-29. https://doi.org/10.1016/j.jacc.2013.02.098
Sever PS, et al. Evaluation of C-reactive Protein Before and On-treatment as a Predictor of Benefit of Atorvastatin: a Cohort Analysis From the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-lowering Arm. J Am Coll Cardiol. 2013 Aug 20;62(8):717-29. PubMed PMID: 23948514.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of C-reactive protein before and on-treatment as a predictor of benefit of atorvastatin: a cohort analysis from the Anglo-Scandinavian Cardiac Outcomes Trial lipid-lowering arm. AU - Sever,Peter S, AU - Poulter,Neil R, AU - Chang,Choon L, AU - Thom,Simon A M, AU - Hughes,Alun D, AU - Welsh,Paul, AU - Sattar,Naveed, AU - ,, PY - 2012/09/27/received PY - 2013/02/12/revised PY - 2013/02/19/accepted PY - 2013/8/17/entrez PY - 2013/8/21/pubmed PY - 2014/2/5/medline KW - BMI KW - C-reactive protein KW - CHD KW - CI KW - CRP KW - CVD KW - HDL-C KW - HR KW - IQR KW - LDL-C KW - MI KW - body mass index KW - cardiovascular disease KW - cohort KW - confidence interval KW - coronary heart disease KW - hazard ratio KW - high-density lipoprotein cholesterol KW - interquartile range KW - low-density lipoprotein cholesterol KW - myocardial infarction KW - study SP - 717 EP - 29 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 62 IS - 8 N2 - OBJECTIVES: The aim of this study was to determine whether baseline and on-statin C-reactive protein (CRP) are independent predictors of cardiovascular (CV) outcome beyond low-density lipoprotein cholesterol (LDL-C). BACKGROUND: Use of CRP as a predictor of statin treatment remains controversial. METHODS: We investigated the relationship of baseline and on-treatment CRP with subsequent CV events in Cox models using a subset of white subjects with no history of CV disease from the UK ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial). RESULTS: During 5.5 years of follow-up, a total of 488 subjects experienced a CV event. CV risk increased with baseline CRP (hazard ratio [HR] per 1 SD: 1.21; 95% confidence interval [CI]: 1.09 to 1.33) in an adjusted model. In ASCOT Lipid-Lowering Arm, the relative statin effect in preventing CV events did not differ according to tertiles of baseline CRP (p = 0.69). After 6 months of atorvastatin therapy, the median LDL-C and CRP were reduced by 38.7% and 25.8%, respectively. Those who achieved LDL-C below the median had a reduced CV risk (HR: 0.58; 95% CI: 0.34 to 0.97) compared with those who did not. In contrast, those who achieved a CRP level below the median did not have a reduced risk of CV events (HR: 0.95; 95% CI: 0.59 to 1.55). Among those who achieved LDL-C below the median, there was no difference in CV risk whether they also achieved a CRP level below (HR: 0.55; 95% CI: 0.30 to 1.02) or above the median (HR: 0.56; 95% CI: 0.30 to 1.03). CONCLUSIONS: In these primary prevention patients, although baseline CRP independently predicted CV event risk, the achieved CRP level on while statin therapy did not predict CV events, either alone or in combination with LDL-C. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/23948514/Evaluation_of_C_reactive_protein_before_and_on_treatment_as_a_predictor_of_benefit_of_atorvastatin:_a_cohort_analysis_from_the_Anglo_Scandinavian_Cardiac_Outcomes_Trial_lipid_lowering_arm_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(13)02371-1 DB - PRIME DP - Unbound Medicine ER -