Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet, S0140673623002155. https://doi.org/10.1016/S0140-6736(23)00215-5 Dr. Paul Ridker et al.
Points
- The study examined the importance of high-sensitivity CRP and LDLC in predicting cardiovascular events in patients receiving contemporary statin therapy.
- The analysis included 31,245 patients from three trials: PROMINENT, REDUCE-IT, and STRENGTH.
- Results showed inflammation assessed by high-sensitivity CRP was significantly associated with cardiovascular events and death, while cholesterol assessed by LDLC was not.
- Findings suggest that aggressive lipid-lowering and inflammation-inhibiting therapies may be needed to reduce atherosclerotic risk in these patients.
- The study authors recommend further research to confirm these results and guide the selection of adjunctive treatments beyond statin therapy.
Summary
This research paper evaluated the importance of high-sensitivity C-reactive protein (CRP) and low-density lipoprotein cholesterol (LDLC) in predicting the risk of major adverse cardiovascular events, cardiovascular death, and all-cause death among patients receiving statin therapy. The study analyzed data from three multinational trials – PROMINENT (n=9988), REDUCE-IT (n=8179), and STRENGTH (n=13,078) – comprising a total of 31,245 patients with atherosclerotic disease who were receiving contemporary statins.
The study found that residual inflammatory risk, as assessed by high-sensitivity CRP, was significantly associated with incident major adverse cardiovascular events (adjusted HR 1.31, 95% CI 1.20-1.43; p<0.0001), cardiovascular mortality (adjusted HR 2.68, 95% CI 2.22-3.23; p<0.0001), and all-cause mortality (adjusted HR 2.42, 95% CI 2.12-2.77; p<0.0001). On the other hand, residual cholesterol risk, as assessed by LDLC, had a neutral or low magnitude relationship with these events, with the highest LDLC quartile versus the lowest LDLC quartile having an adjusted HR of 1.07 (95% CI 0.98-1.17; p=0.11) for major adverse cardiovascular events, an adjusted HR of 1.27 (95% CI 1.07-1.50; p=0.0086) for cardiovascular death, and an adjusted HR of 1.16 (95% CI 1.03-1.32; p=0.025) for all-cause death.
The study’s results suggest that among patients receiving contemporary statins, inflammation assessed by high-sensitivity CRP was a stronger predictor of the risk of future cardiovascular events and death than cholesterol assessed by LDLC. The findings have implications for the choice of adjunctive treatments beyond statin therapy and suggest that combining aggressive lipid-lowering and inflammation-inhibiting therapies may be necessary to reduce atherosclerotic risk further.
Link to the article: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00215-5/
References Ridker, P. M., Bhatt, D. L., Pradhan, A. D., Glynn, R. J., MacFadyen, J. G., & Nissen, S. E. (2023). Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: A collaborative analysis of three randomised trials. The Lancet, S0140673623002155. https://doi.org/10.1016/S0140-6736(23)00215-5
