Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events
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BACKGROUND: Elevated levels of C-reactive protein, even in the absence of hyperlipidemia, are associated with an increased risk of coronary events. Statin therapy reduces the level of C-reactive protein independently of its effect on lipid levels. We hypothesized that statins might prevent coronary events in persons with elevated C-reactive protein levels who did not have overt hyperlipidemia. METHODS: The level of C-reactive protein was measured at base line and after one year in 5742 participants in a five-year randomized trial of lovastatin for the primary prevention of acute coronary events. RESULTS: The rates of coronary events increased significantly with increases in the base-line levels of C-reactive protein. Lovastatin therapy reduced the C-reactive protein level by 14.8 percent (P<0.001), an effect not explained by lovastatin-induced changes in the lipid profile. As expected, lovastatin was effective in preventing coronary events in participants whose base-line ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol was higher than the median ratio, regardless of the level of C-reactive protein (number needed to treat for five years to prevent 1 event, 47; P=0.005). However, lovastatin was also effective among those with a ratio of total to HDL cholesterol that was lower than the median and a C-reactive protein level higher than the median (number needed to treat, 43; P=0.02). In contrast, lovastatin was ineffective among participants with a ratio of total to HDL cholesterol and a C-reactive protein level that were both lower than the median (number needed to treat, 983; P=0.80). CONCLUSIONS: Statin therapy may be effective in the primary prevention of coronary events among subjects with relatively low lipid levels but with elevated levels of C-reactive protein.
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In a post hoc analysis of the AFCAPS/TexCAPS trial, statin therapy remained effective at mitigating risk in individuals with elevated high-sensitivity C-reactive protein but low LDL-C.
“In an intriguing post hoc analysis of the AFCAPS/TexCAPS (Air Force/Texas Coronary Atherosclerosis Prevention Study), investigators observed that statin therapy remained effective at mitigating risk in individuals with elevated high-sensitivity C-reactive protein but low LDL-C (28)”
From Triglycerides and residual atherosclerotic risk (2021) · cites this paper as [28]
The presence of an abdominal aortic aneurysm represents a risk-equivalent condition for CAD.
“The presence of an abdominal aortic aneurysm represents a riskequivalent condition for CAD and is associated with age, male gender, personal history of atherosclerotic CVD, smoking, hypertension, and dyslipidaemia [519]; in contrast, diabetic patients are at decreased risk.”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [519]
Abdominal aortic aneurysm is linked to older age, male sex, prior atherosclerotic CVD, smoking, hypertension, and dyslipidaemia.
“The presence of an abdominal aortic aneurysm represents a riskequivalent condition for CAD and is associated with age, male gender, personal history of atherosclerotic CVD, smoking, hypertension, and dyslipidaemia [519]; in contrast, diabetic patients are at decreased risk.”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [519]
Diabetic patients are at decreased risk of abdominal aortic aneurysm.
“The presence of an abdominal aortic aneurysm represents a riskequivalent condition for CAD and is associated with age, male gender, personal history of atherosclerotic CVD, smoking, hypertension, and dyslipidaemia [519]; in contrast, diabetic patients are at decreased risk.”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [519]
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- Authors
- Ridker, P. M., Rifai, N., Clearfield, M., Downs, J. R., Weis, S. E., Miles, J. S., & Gotto, A. M.
- Affiliations
- Brigham and Women's Hospital (US)
- University of North Texas Health Science Center (US)
- Wilford Hall Ambulatory Surgical Center (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2001-06-28
- Volume
- 344
- Issue
- 26
- Pages
- 1959-1965
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2316243284
- Cited by
- 1,557
- References
- 27
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 16 · 2023: 29 · 2022: 34 · 2021: 30 · 2020: 35 · 2019: 38 · 2018: 29 · 2017: 25 · 2016: 39 · 2015: 41 · 2014: 39 · 2013: 43 · 2012: 52
- FWCI
- 158.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Doris Duke Charitable Foundation
- American Heart Association
- Fondation Leducq
- National Heart, Lung, and Blood Institute (R01HL058755, HL-58755)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- C-reactive protein, statin therapy, lovastatin, primary prevention, acute coronary events, cardiovascular risk stratification, TC/HDL-C ratio, hyperlipidemia, inflammation, number needed to treat
- MeSH terms
- Acute Disease, Anticholesteremic Agents, C-Reactive Protein, Cholesterol, Coronary Disease, Double-Blind Method, Follow-Up Studies, Humans, Cholesterol, HDL, Lovastatin, Primary Prevention, Risk, Risk Factors, Proportional Hazards Models, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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