Evidence from a study of 31,245 patients already taking statin therapy has indicated that inflammation may be a more ‘powerful’ predictor of risk of future cardiovascular events, such as stroke, than bad cholesterol.
The study’s corresponding author, Paul Ridker, MD, believes that treatments that aggressively lower vascular inflammation need to be incorporated into daily practise in order to maximise patient outcomes.
Ridker, says: “The new data should be a wake-up call for preventive cardiologists and their patients.
“Virtually all patients with or at risk for atherosclerotic disease are appropriately treated with aggressive statin therapy. Yet, in our study of patients already taking a statin, hsCRP — a measure of residual inflammatory risk — was a more powerful determinant of having a future heart attack or dying from cardiovascular disease than was LDL- cholesterol – a measure of residual cholesterol risk. The data are a powerful demonstration that to beat heart disease, we need to lower both cholesterol and inflammation, not just cholesterol alone.”
Once a patient is using statins, cardiologists typically describe two conditions: Residual cholesterol risk (can be further reduced with additional limi-lowering therapy) and Residual Inflammatory risk (can be further reduced with certain drugs that impact vascular inflammation.)
Whether clinicians should choose to focus on further lowering cholesterol or inflammation has been uncertain and controversial.
In this study, data was examined from three recently conducted trials (PROMINENT, REDUCE-IT and STRENGTH) of patients with or at high risk for atherosclerotic disease to understand the importance of residual inflammatory risk, as compared to residual cholesterol risk, among contemporary statin-treated patients.
All patients were receiving aggressive guideline directed medical care including statins, usually at high doses.
Cardiovascular event rates in all three trials approached 10 per cent at five years.
In all three trials, blood levels of high-sensitivity C-reactive protein (hs-CRP) were significantly associated with major adverse cardiovascular events, cardiovascular mortality and all-cause mortality.
Furthermore, the researchers report that hs-CRP was a more potent predictor of future cardiovascular risk than LDL cholesterol. For example, among aggressively treated patients already on higher intensity statins, the risk of cardiovascular death and all-cause mortality were more than twice as high among those with the highest levels of CRP when compared to those with the highest levels of cholesterol, differences that were highly statistically significant.
