Statin therapy, lipid levels, C-reactive protein and the survival of patients with angiographically severe coronary artery disease

OBJECTIVE The joint predictive value of lipid and C-reactive protein (CRP) levels, as well as a possible interaction between statin therapy and CRP, w ere evaluated for survival after angiographic diagnosis of coronary artery disease (CAD). BACKGROUND Hyperlipidemia increases risk of CAD and myocardial infarction. For first myocardial infarction, the combination of lipid and CRP levels ma y be prognostically more powerful. Although lipid levels are often measured at angiography to guide therapy, their prognostic value is unclear. METHODS Blood samples were collected from a prospective cohort of 985 patie nts diagnosed angiographically with severe CAD (stenosis greater than or eq ual to 70%) and tested far total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and CRP levels. Key risk factors, in cluding initiation of statin therapy, were recorded, and subjects were foll owed for an average of 3.0 years (range: 1.8 to 4.3 years) to assess surviv al. RESULTS Mortality was confirmed for 109 subjects (11%). In multiple variabl e Cox regression, levels of TC, LDL, HDL and the TC:HDL ratio did not predi ct survival, but statin therapy was protective (adjusted hazard ratio [HR] = 0.49, p = 0.04). C-reactive protein levels, age, left ventricular ejectio n fraction and diabetes were also independently predictive. Statins primari ly benefited subjects with elevated CRP by eliminating the increased mortal ity across increasing CRP tertiles (statins: HR = 0.97 per tertile, p-trend = 0.94; no statins: HR = 1.8 per tertile, p-trend < 0.0001). CONCLUSIONS Lipid levels drawn at angiography were not predictive of surviv al in this population, but initiation of statin therapy was associated with . improved survival regardless of the lipid levels. The benefit of statin t herapy occurred primarily in patients with elevated CRP. (C) 2000 by the Am erican College of Cardiology.