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CRP as good as cholesterol as indicator of statins benefit

By Lilian Anekwe

Reductions in the inflammatory marker C-reactive protein predict the benefits of a statin at least as well as falls in cholesterol level, new research reveals.

The study may alter perceptions of how statins work and could even herald the introduction of targets for CRP reduction alongside those for cholesterol levels.

Researchers found reductions in high-sensitivity C-reactive protein were associated with a similar and perhaps even greater fall in cardiovascular risk than reductions in LDL cholesterol.

The analysis found healthy patients with raised initial hsCRP, whose levels of the protein fell to less than 2mg/l after treatment with rosuvastatin 20mg, had a 62% reduction in CVD risk compared with those on placebo.

By comparison patients whose LDL-cholesterols levels were lowered to less than 1.8mmol/l had a 55% reduction in risk compared with placebo.

Patients whose hsCRP levels fell to less than 2mg/l and LDL-cholesterol to less than 1.8 mmol/l saw their risk of cardiovascular events reduce by 65%, and those with an LDL-cholesterol level of less than 1.8mmol/l and an hsCRP level of less than 1mg/l saw a 79% decrease.

The analysis of more than 15,000 US patients from the JUPITER trial was published online by The Lancet and presented at the American College of Cardiology conference in Orlando this week.

Study leader Dr Paul Ridker, professor of medicine at the Brigham and Women's hospital in Boston, concluded: ‘For people choosing to start pharmacological prophylaxis, reductions in both LDL cholesterol and hsCRP are indicators of the success of treatment with statin therapy.'

Dr Terry McCormack, former chair of the primary care cardiovascular society and a GP in Whitby, North Yorkshire, said the study was ‘scientifically interesting.'

But he added: ‘The hsCRP test is expensive at £7.80 and only available locally from the Brigham and Women's hospital whereas CRP is used very widely by GPs in the UK.'

Dr George Kassianos, a fellow of the European Society of Cardiology and a GP in Bracknell, Berkshire, said: ‘If we are going to have an effect globally we need to increase HDL-cholesterol, reduce LDL-cholesterol and decrease the inflammatory process.'

Reductions in high-sensitivity C-reactive protein were associated with a similar and perhaps even greater fall in cardiovascular risk than reductions in LDL cholesterol. Rosuvastatin

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