C-Reactive Protein Levels and Outcomes after Statin Therapy

Ridker, Paul M; Cannon, Christopher P.; Morrow, David; Rifai, Nader; Rose, Lynda M.; McCabe, Carolyn H.; Pfeffer, Marc A.; Braunwald, Eugene

doi:10.1056/nejmoa042378

Cited by 2,292Lipoproteins and Cardiovascular HealthAcute Myocardial Infarction ResearchCancer, Lipids, and Metabolism

C-Reactive Protein Levels and Outcomes after Statin Therapy

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Ridker, Paul M, Cannon, Christopher P., Morrow, David, Rifai, Nader, Rose, Lynda M., McCabe, Carolyn H., Pfeffer, Marc A., Braunwald, Eugene·2005·New England Journal of Medicine

DOI 10.1056/nejmoa042378

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Abstract

BACKGROUND: Statins lower the levels of low-density lipoprotein (LDL) cholesterol and C-reactive protein (CRP). Whether this latter property affects clinical outcomes is unknown. METHODS: We evaluated relationships between the LDL cholesterol and CRP levels achieved after treatment with 80 mg of atorvastatin or 40 mg of pravastatin per day and the risk of recurrent myocardial infarction or death from coronary causes among 3745 patients with acute coronary syndromes. RESULTS: Patients in whom statin therapy resulted in LDL cholesterol levels of less than 70 mg per deciliter (1.8 mmol per liter) had lower event rates than those with higher levels (2.7 vs. 4.0 events per 100 person-years, P=0.008). However, a virtually identical difference was observed between those who had CRP levels of less than 2 mg per liter after statin therapy and those who had higher levels (2.8 vs. 3.9 events per 100 person-years, P=0.006), an effect present at all levels of LDL cholesterol achieved. For patients with post-treatment LDL cholesterol levels of more than 70 mg per deciliter, the rates of recurrent events were 4.6 per 100 person-years among those with CRP levels of more than 2 mg per liter and 3.2 events per 100 person-years among those with CRP levels of less than 2 mg per liter; the respective rates among those with LDL cholesterol levels of less than 70 mg per deciliter were 3.1 and 2.4 events per 100 person-years (P<0.001). Although atorvastatin was more likely than pravastatin to result in low levels of LDL cholesterol and CRP, meeting these targets was more important in determining the outcomes than was the specific choice of therapy. Patients who had LDL cholesterol levels of less than 70 mg per deciliter and CRP levels of less than 1 mg per liter after statin therapy had the lowest rate of recurrent events (1.9 per 100 person-years). CONCLUSIONS: Patients who have low CRP levels after statin therapy have better clinical outcomes than those with higher CRP levels, regardless of the resultant level of LDL cholesterol. Strategies to lower cardiovascular risk with statins should include monitoring CRP as well as cholesterol.

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Apolipoprotein B, LDL cholesterol, and hs-CRP are well-established risk factors associated with differences in cardiovascular event rates in clinical trials.
“Given that these parameters are well-established risk factors associated with differences in cardiovascular event rates in clinical trials, 26-28”
From Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk (2020) · cites this paper as [26]
The paper’s Results (page not specified in our copy) report different recurrent coronary-event rates according to LDL cholesterol and CRP levels achieved after statin therapy; it specifies that CRP was measured with a high-sensitivity assay. The cited paper does not establish the apolipoprotein B part of the claim. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Fenofibrate reduces the progression of diabetic retinopathy.
“Fenofibrate reduces the progression of diabetic retinopathy [517,518].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [517]

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Authors: Ridker, P. M., Cannon, C. P., Morrow, D., Rifai, N., Rose, L. M., McCabe, C. H., Pfeffer, M. A., & Braunwald, E.
Affiliations: Brigham and Women's Hospital (US)
ORCID: Ridker, Paul M
Cannon, Christopher P.
Morrow, David
Rifai, Nader
Rose, Lynda M.
Pfeffer, Marc A.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2005-01-06
Volume: 352
Issue: 1
Pages: 20-28
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa042378
OpenAlex: W2118154631
Cited by: 2,292
References: 28
Citations by year: 2026: 32 · 2025: 46 · 2024: 47 · 2023: 52 · 2022: 70 · 2021: 58 · 2020: 74 · 2019: 64 · 2018: 72 · 2017: 54 · 2016: 78 · 2015: 62 · 2014: 67 · 2013: 93 · 2012: 88
FWCI: 282.76
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
Keywords: C-reactive protein, statin therapy, LDL cholesterol, atorvastatin, pravastatin, acute coronary syndrome, reinfarction, coronary death, cardiovascular risk, lipid-lowering targets
MeSH terms: Atorvastatin, Gatifloxacin, Anticholesteremic Agents, C-Reactive Protein, Coronary Disease, Female, Heptanoic Acids, Humans, Cholesterol, LDL, Male, Middle Aged, Myocardial Infarction, Pyrroles, Risk Factors, Biomarkers, Incidence, Proportional Hazards Models, Pravastatin, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Fluoroquinolones, Secondary Prevention

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