Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events

Background: Elevated levels of C-reactive protein, even in the absence of h yperlipidemia, are associated with an increased risk of coronary events. St atin therapy reduces the level of C-reactive protein independently of its e ffect on lipid levels. We hypothesized that statins might prevent coronary events in persons with elevated C-reactive protein levels who did not have overt hyperlipidemia. Methods: The level of C-reactive protein was measured at base line and afte r one year in 5742 participants in a five-year randomized trial of lovastat in for the primary prevention of acute coronary events. Results: The rates of coronary events increased significantly with increase s in the base-line levels of C-reactive protein. Lovastatin therapy reduced the C-reactive protein level by 14.8 percent (P<0.001), an effect not expl ained by lovastatin-induced changes in the lipid profile. As expected, lova statin was effective in preventing coronary events in participants whose ba se-line ratio of total cholesterol to high-density lipoprotein (HDL) choles terol was higher than the median ratio, regardless of the level of C-reacti ve protein (number needed to treat for five years to prevent 1 event, 47; P =0.005). However, lovastatin was also effective among those with a ratio of total to HDL cholesterol that was lower than the median and a C-reactive p rotein level higher than the median (number needed to treat, 43; P=0.02). I n contrast, lovastatin was ineffective among participants with a ratio of t otal to HDL cholesterol and a C-reactive protein level that were both lower than the median (number needed to treat, 983; P=0.87). Conclusions: Statin therapy may be effective in the primary prevention of c oronary events among persons with relatively low lipid levels but with elev ated levels of C-reactive protein. (N Engl J Med 2001;344:1959-65.) Copyrig ht (C) 2001 Massachusetts Medical Society.