Statins reduce the rate of first myocardial infarction, stroke, or confirmed cardiovascular death by 47% in patients with LDL-C <130 mg/dl and hsCRP >2 mg/l (HR 0.53; 95% CI 0.40-0.69; p<0.00001).
Do statins reduce first myocardial infarction, stroke, or confirmed cardiovascular death in patients with low-density lipoprotein-C levels of <130 mg/dl and hsCRP of >2 mg/l?
High-sensitivity C-reactive protein (hsCRP) is a valuable prognostic biomarker that can guide statin therapy in primary prevention, particularly when LDL-C is <130 mg/dl and clinical decisions are uncertain.
Effect estimate: HR 0.53 (95% CI 0.40 to 0.69)
p-value: p=< 0.00001
The inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) adds prognostic information on cardiovascular risk comparable to blood pressure or cholesterol. Values 3 mg/l indicate lower, average, or higher relative cardiovascular risk, respectively. Global risk algorithms that include hsCRP outperform those solely using Framingham covariates. Although diet, exercise, and smoking cessation are first steps for patients with a proinflammatory response, JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial data demonstrate that statins reduce by 47% the rate of first myocardial infarction, stroke, or confirmed cardiovascular death when given to patients with low-density lipoprotein-C levels of 2 mg/l (hazard ratio: 0.53; 95% confidence interval: 0.40 to 0.69; p < 0.00001). In current U.S. guidelines, hsCRP carries a class IIb assessment and is most appropriate in primary prevention when clinical decisions to initiate statin therapy are uncertain. Ongoing multinational trials are pursuing whether reducing inflammation will decrease vascular event rates.
Paul M. Ridker (2016) conducted a review in Cardiovascular risk. Statins was evaluated on First myocardial infarction, stroke, or confirmed cardiovascular death (HR 0.53, 95% CI 0.40 to 0.69, p=< 0.00001). Statins reduce the rate of first myocardial infarction, stroke, or confirmed cardiovascular death by 47% in patients with LDL-C <130 mg/dl and hsCRP >2 mg/l (HR 0.53; 95% CI 0.40-0.69; p<0.00001).