What is the clinical evidence from this study?

Study design: Cohort. Population: PCI-naïve patients on statin therapy (n=4803). Intervention: Highest quartile of followed-up hsCRP vs. Lowest quartile of followed-up hsCRP. Primary outcome: Total major adverse cardiovascular events (MACE) (HR 2.16, p=<0.001).

What does this research mean for the field?

In PCI-naïve patients on moderate statin therapy, high followed-up high-sensitivity C-reactive protein (hsCRP) levels are associated with a significantly higher incidence of 5-year major adverse cardiovascular events, whereas achieved LDL-C levels show no such association. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 21, 2019Open Access

Roles of Achieved Levels of Low-Density Lipoprotein Cholesterol and High-Sensitivity C-Reactive Protein on Cardiovascular Outcome in Statin Therapy

Q: What are the key findings of this study?

The highest quartile of followed-up hsCRP was associated with a higher incidence of 5-year MACE compared to the lowest quartile (HR 2.16, p<0.001), whereas achieved LDL-C showed no difference.

Q: What does this research mean for the field?

In PCI-naïve patients on moderate statin therapy, high followed-up high-sensitivity C-reactive protein (hsCRP) levels are associated with a significantly higher incidence of 5-year major adverse cardiovascular events, whereas achieved LDL-C levels show no such association. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

MHMyung Han HyunNational Cancer Center YLYu-Chang LeeKorea University Medical Center BCByoung Geol ChoiPyeongtaek University

Key Result

The highest quartile of followed-up hsCRP was associated with a higher incidence of 5-year MACE compared to the lowest quartile (HR 2.16, p<0.001), whereas achieved LDL-C showed no difference.

Study Design

Type

Cohort (n=4,803)

Structured PICO

Does achieved hsCRP or LDL-C better predict cardiovascular outcomes in PCI-naïve patients on moderate-intensity statin therapy?

Population

4,803 percutaneous coronary intervention (PCI)-naïve patients prescribed moderate intensity statin therapy

Intervention

Highest quartile of achieved high-sensitivity C-reactive protein (hsCRP) or low-density lipoprotein cholesterol (LDL-C)

Comparator

Lowest quartile of achieved hsCRP or LDL-C

Outcome

Total major adverse cardiovascular events (MACE) at 5 yearscomposite

In PCI-naïve patients on moderate-intensity statin therapy, achieved hsCRP levels may be a better predictor of future cardiovascular outcomes than achieved LDL-C levels.

Main Result

Effect estimate: HR 2.16

p-value: p=<0.001

Abstract

In statin therapy, the prognostic role of achieved low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) in cardiovascular outcomes has not been fully elucidated. A total of 4,803 percutaneous coronary intervention (PCI)-naïve patients who prescribed moderate intensity of statin therapy were followed up. Total and each component of major adverse cardiovascular events (MACE) according to LDL-C and hsCRP quartiles were compared. The incidence of 5-year total MACEs in the highest quartile group according to the followed-up hsCRP was higher than that in the lowest quartile (hazard ratio (HR) = 2.16, p0.001). However, there was no difference between the highest and lowest quartiles of the achieved LDL-C (HR = 0.95, p=0.743). After adjustment of potential confounders, the incidence of total death, de novo PCI, atrial fibrillation, and heart failure in the highest quartile of followed-up hsCRP, was higher than that in the lowest quartile (all p0.05). However, other components except for de novo PCI in the highest quartile by achieved LDL-C was not different to that in the lowest quartile. These results suggest that followed-up hsCRP can be more useful for predicting future cardiovascular outcome than achieved LDL-C in PCI-naïve patients with statin therapy.

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