News Release

Statins are highly effective even in patients with lower levels of systemic inflammation

Peer-Reviewed Publication

The Lancet_DELETED

It has been suggested that a person's level of systemic inflammation, as measured by levels of C-reactive protein (CRP) in the blood, could modify their response to statin therapy. A study published Online First and in an upcoming Lancet shows that this is not the case, and that statins are at least as effective in patients with low levels of inflammation as they are in other patients. The Article is from the Heart Protection Study Collaborative Group with Dr Jonathan Emberson taking the lead for the group in this analysis. The group, who are based at the Clinical Trial Service Unit, University of Oxford, UK, published the main results of the Heart Protection Study in The Lancet in 2002.

For this paper, the authors analysed more than 20,000 patients who took part in the Heart Protection Study between 1994 and 2001. They were aged 40 to 80 years at high risk of vascular events, and from 69 UK hospitals. Patients were assigned to receive either simvastatin 40mg daily or matching placebo for a mean of five years. They were monitored for occurrence of coronary-related death, heart attack, stroke, or intervention for revascularisation.

Overall, patients assigned to simvastatin had a highly significant 24% reduction in the risk of a major vascular event, with no evidence that CRP has any significant effect on this reduction. Even in patients with the lowest CRP levels, statins reduced major vascular events by the same amount of about one quarter. Indeed, any combination of low or high CRP with low or high bad (LDL) cholesterol appeared to have little impact on the benefits of the statin.

The authors conclude: "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. The results could be applicable to all statins (not only simvastatin) and are likely to be applicable to a wide range of people with and without pre-existing vascular disease."

In a linked Comment, Dr Jean-Pierre Després, l'Institut universitaire de cardiologie et de pneumologie de Québec, and Université Laval, Québec, QC, Canada, points out that LDL-cholesterol and CRP concentrations assessed at baseline were both associated with the absolute vascular event rate (see figure in full Comment). He adds that "although the highest event rate was recorded in patients with both high LDL-cholesterol and CRP concentrations, patients given simvastatin who had low baseline CRP concentrations had the lowest rate of vascular events irrespective of their baseline LDL-cholesterol values. Thus, although all subgroups benefitted from statin therapy, both LDL-cholesterol and CRP concentrations were clearly associated with major vascular event rates".

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Dr Jonathan Emberson, Clincal Trial Service Unit, University of Oxford, UK. T) +44 (0)1865 743743 E) jonathan.emberson@ctsu.ox.ac.uk

Dr Jean-Pierre Després, l'Institut universitaire de cardiologie et de pneumologie de Québec, and Université Laval, Québec, QC, Canada. T) +1 418 656-4863 E) jean-pierre.despres@criucpq.ulaval.ca

For full Article and Comment, see: http://press.thelancet.com/crp.pdf

NOTE: THE ABOVE LINK IS FOR JOURNALISTS ONLY; IF YOU WISH TO PROVIDE A LINK TO THE FREE ABSTRACT OF THIS PAPER FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62174-5/abstract


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