Statins reduce this buildup by reducing C-reactive protein, a measure of inflammation in the arteries. A related analysis at Boston’s Brigham and Women’s Hospital demonstrates that lowering C-reactive protein (CRP) levels with statins also reduces the risk of recurrent heart attack.
The Cleveland Clinic study analyzed the results of the REVERSAL trial, which found that intensive treatment with atorvastatin (marketed as Lipitor by Pfizer) halted the progression of atherosclerosis, or plaque build-up in the arteries, while the moderate pravastatin (Bristol-Myers Squibb’s Pravachol) treatment did not stop progression of the disease.
In the study, researchers report that intensive therapy with atorvastatin reduced CRP levels 36%, while the more moderate pravastatin regimen reduced CRP by 5%. They also observed that the reductions in CRP were independent of the reduction in cholesterol levels, indicating that the reduction in inflammation produced by the statins was not merely a consequence of lower cholesterol levels. The study demonstrated that both CRP and LDL cholesterol were “independently and significantly” linked to the rate of disease progression.
“Everyone thought the greater benefit of intensive atorvastatin therapy resulted exclusively from the lower cholesterol levels achieved in that group,” said Dr Steven Nissen, author of The Cleveland Clinic study. “As a result of this new analysis, we now know that the more intensively treated patients experienced a decrease in disease progression in large part because they had a greater reduction in inflammation as measured by decreased levels of CRP, not merely because of lower LDL cholesterol.”
At Brigham and Women’s Hospital, Dr Paul Ridker conducted a new analysis of the PROVE-IT trial, also establishing that the more intensive atorvastatin regimen produced greater reductions in both CRP and LDL levels. Dr Ridker’s study demonstrated that greater lowering in both CRP and LDL levels was strongly associated with a reduced rate of recurrent cardiac events. The risk of an adverse event was lowest in patients in whom both CRP and LDL were substantially reduced, compared to patients with lesser reductions in these two biomarkers.
Thus, both studies found that patients with above-average reductions in CRP and LDL showed greater benefits than patients with lesser reduction in these two biomarkers.
“These findings strongly suggest that we should target statin therapy at reducing CRP, not just cholesterol,” Dr Nissen concluded.