The Lancet has published the results of a retrospective analysis of date from the Heart Protection Study that aimed to assess whether individuals with raised baseline C-reactive protein (CRP) levels would gain greater benefit from statin therapy. This study acknowledges the JUPITER study which studied the effect of rosuvastatin for primary prevention of cardiovascular events in individuals with low levels of low density lipoprotein cholesterol (LDL-C) but high risk of a cardiovascular event based on age and high sensitivity CRP.
HPS randomly assigned 20,536 men and women aged 40 to 80 years old who were at high risk of vascular events to treatment with simvastatin 40mg daily or placebo. Follow up was for 5 years with a composite primary endpoint including coronary death, myocardial infarction, stroke or revascularisation.
2,727 of the participants in the study also had baseline and follow up data for CRP and (LDL-C). In this subset of patients, treatment with simvastatin resulted in an average reduction of 0.85mmol/L in LDL-C and 0.32 log mg/L in CRP. This equates to a relative reduction 25% and 27% respectively.
Treatment with simvastatin in the study also resulted in a 24% proportional risk reduction in the primary endpoint and this reduction did not vary greatly in 6 predefined bands of baseline CRP. In patients with a baseline CRP of <1.25mg/L given simvastatin there was a risk reduction of 29% compared to those given placebo.
The authors conclude that, "evidence from this large-scale randomised trial does not lend support to the hypothesis that baseline CRP concentration modifies the vascular benefits of statin therapy materially". They do not that this analysis only reviews data on simvastatin and my not be applicable to other statins. However, they also note that the benefits of statins can be largely explained through the effect on LDL-C and that the reductions in LDL-C and CRP observed in this data are of a similar ratio to that observed with rosuvastatin in the JUPITER study. They also note that the size of the study and the wide range of LDL-C and CRP baseline figures allow for a robust analysis.
Action: Statins are of benefit to patients across a range of LDL-C and CRP baseline levels. Eligibility for statin therapy is currently based on the presence of cardiovascular disease or a high risk of developing cardiovascular disease. In the future, CRP may help identify individuals who are at high risk that are not identified with the current risk prediction tools but additional research is needed.