CRP levels do not predict statin therapy success

C-reactive protein (CRP) levels are not a helpful indicator of whether statins are likely to be effective in particular patients, UK research suggests.

The impact of statin therapy was assessed in 20,000 patients (Photograph: SPL)
The impact of statin therapy was assessed in 20,000 patients (Photograph: SPL)

The finding runs contrary to previous work suggesting that systemic inflammation, as measured by blood CRP levels, modified the impact of statins. But researchers led by Dr Jonathan Emberson of Oxford University found that CRP did not modify the effect of treatment with statins.

Statin therapy lowered risk of a major vascular event, even in patients with low LDL and low CRP levels.

The study examined data from 20,000 patients from the Heart Protection Study, which ran from 1994 to 2001.

Patients were aged 40 to 80 years and at high risk of vascular events. They were randomised to five years' treatment with either simvastatin 40mg daily or placebo.

Patients were tested for CRP at baseline and in the final study year. The primary outcome was the occurrence of a major vascular event, including a composite of coronary death, MI, stroke or revascularisation.

Treatment with simvastatin reduced major vascular events by 24 per cent compared with the placebo group.

But researchers found no link between proportional reduction in primary outcomes and baseline CRP. Simvastatin reduced risk of a vascular event regardless of baseline or final blood CRP levels. This was even the case in patients with low baseline CRP levels, for whom major vascular events were reduced by 29 per cent.

Researchers concluded: 'The results do not lend support to the suggestion that the beneficial effects of statin therapy are affected by baseline CRP concentration or, more generally, by inflammation status.'

Researchers said the results may apply to all statins and not just simvastatin. The result may also apply to treatment for a wide range of patients with or without pre-existing vascular disease, they added.

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Lancet online 2010

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