Cited by 1,557Lipoproteins and Cardiovascular HealthCancer, Lipids, and MetabolismAcute Myocardial Infarction Research

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Measurement of C-Reactive Protein for the Targeting of Statin Therapy in the Primary Prevention of Acute Coronary Events

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Ridker, Paul M., Rifai, Nader, Clearfield, Michael, Downs, John R., Weis, Stephen E., Miles, J. Shawn, Gotto, Antonio M.·2001·New England Journal of Medicine

DOI 10.1056/nejm200106283442601

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Abstract

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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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)
ORCID: Ridker, Paul M.
Rifai, Nader
Weis, Stephen E.
Gotto, Antonio M.
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
DOI: 10.1056/nejm200106283442601
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 › Cardiology and Cardiovascular Medicine › 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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Measurement of C-Reactive Protein for the Targeting of Statin Therapy in the Primary Prevention of Acute Coronary Events

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