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

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Abstract

OBJECTIVES

The joint predictive value of lipid and C-reactive protein (CRP) levels, as well as a possible interaction between statin therapy and CRP, were 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 may 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 patients diagnosed angiographically with severe CAD (stenosis ≥ 70%) and tested for total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and CRP levels. Key risk factors, including initiation of statin therapy, were recorded, and subjects were followed for an average of 3.0 years (range: 1.8 to 4.3 years) to assess survival.

RESULTS

Mortality was confirmed for 109 subjects (11%). In multiple variable Cox regression, levels of TC, LDL, HDL and the TC:HDL ratio did not predict survival, but statin therapy was protective (adjusted hazard ratio [HR] = 0.49, p = 0.04). C-reactive protein levels, age, left ventricular ejection fraction and diabetes were also independently predictive. Statins primarily benefited subjects with elevated CRP by eliminating the increased mortality 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 survival in this population, but initiation of statin therapy was associated with improved survival regardless of the lipid levels. The benefit of statin therapy occurred primarily in patients with elevated CRP.

Abbreviations

CAD
coronary artery disease
CI
95% confidence interval
CRP
C-reactive protein
HDL
high-density lipoprotein
HR
hazard ratio
LDL
low-density lipoprotein
LVEF
left ventricular ejection fraction
MI
myocardial infarction
TC
total cholesterol

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Supported by the LDS Hospital Deseret Foundation, Salt Lake City, Utah.