Effect of Statin Pretreatment and Baseline C-Reactive Protein
Effect of Statin Pretreatment and Baseline C-Reactive Protein
Statins have been demonstrated to improve outcomes after percutaneous coronary intervention (PCI) in a number of studies. Their effects in these studies appear to be more dramatic than those in the primary and secondary preventive trials, suggestive of a mechanism of benefits mediated by alternative pathways in addition to lipid lowering. Furthermore, statins have also been shown to lower serum high-sensitivity C-reactive protein (hsCRP) levels, independent of their effect on cholesterol levels. High-sensitivity CRP has been incontrovertibly established as a predictor for major adverse events following PCI. The current study involved 1552 consecutive patients who underwent elective or urgent PCI. Statin pretreatment before PCI was associated with lowering of periprocedural myocardial infarction and composite death or myocardial infarction at 1 year; these benefits were found predominantly in patients with high baseline hsCRP levels. Statin therapy remained an independent predictor for lower composite risk of mortality and myocardial infarction only among the patients in the highest quartile of baseline hsCRP levels. This study suggests that the benefit of statins within this population may be mediated by attenuation of the deleterious effect of CRP. Future studies need to focus on the utility of hsCRP in guiding medical treatment as well as therapeutic procedures to minimize cardiovascular risk.
When compared with patients who were enrolled in primary and secondary preventive trials for coronary artery disease, patients who presented with acute coronary syndromes (ACS) or underwent percutaneous coronary interventions (PCIs) appeared to derive greater and earlier benefits from statin therapy. This suggests alternative mechanism(s) of benefits with statins other than lipid lowering in these populations. Moreover, statin therapy has also been shown in numerous studies to reduce the serum high-sensitivity C-reactive protein (hsCRP) level, independent of the effect on cholesterol lowering. High-sensitivity CRP has been incontrovertibly proven as an important predictor for major adverse cardiac events among healthy individuals, patients with stable angina or ACS, and patients undergoing PCI. The objective of the current study was to explore whether the effect of statins among PCI patients was linked to their baseline inflammatory status.
Statins have been demonstrated to improve outcomes after percutaneous coronary intervention (PCI) in a number of studies. Their effects in these studies appear to be more dramatic than those in the primary and secondary preventive trials, suggestive of a mechanism of benefits mediated by alternative pathways in addition to lipid lowering. Furthermore, statins have also been shown to lower serum high-sensitivity C-reactive protein (hsCRP) levels, independent of their effect on cholesterol levels. High-sensitivity CRP has been incontrovertibly established as a predictor for major adverse events following PCI. The current study involved 1552 consecutive patients who underwent elective or urgent PCI. Statin pretreatment before PCI was associated with lowering of periprocedural myocardial infarction and composite death or myocardial infarction at 1 year; these benefits were found predominantly in patients with high baseline hsCRP levels. Statin therapy remained an independent predictor for lower composite risk of mortality and myocardial infarction only among the patients in the highest quartile of baseline hsCRP levels. This study suggests that the benefit of statins within this population may be mediated by attenuation of the deleterious effect of CRP. Future studies need to focus on the utility of hsCRP in guiding medical treatment as well as therapeutic procedures to minimize cardiovascular risk.
When compared with patients who were enrolled in primary and secondary preventive trials for coronary artery disease, patients who presented with acute coronary syndromes (ACS) or underwent percutaneous coronary interventions (PCIs) appeared to derive greater and earlier benefits from statin therapy. This suggests alternative mechanism(s) of benefits with statins other than lipid lowering in these populations. Moreover, statin therapy has also been shown in numerous studies to reduce the serum high-sensitivity C-reactive protein (hsCRP) level, independent of the effect on cholesterol lowering. High-sensitivity CRP has been incontrovertibly proven as an important predictor for major adverse cardiac events among healthy individuals, patients with stable angina or ACS, and patients undergoing PCI. The objective of the current study was to explore whether the effect of statins among PCI patients was linked to their baseline inflammatory status.