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Baseline CRP not useful for stratifying statin benefit (MRC HPS)

Clinical Question:
Does high-sensitivity C-reactive protein predict statin response in patients at high risk of vascular events?

Bottom Line:
In contrast to the findings of the JUPITER trial, this secondary analysis of specimens from the Medical Research Council/British Heart Foundation Heart Protection Study found that high-sensitivity C-reactive protein (hsCRP) levels did not identify whether patients at high risk of vascular events benefit from statin therapy. (LOE = 1b)

Reference:
Heart Protection Study Collaborative Group. C-reactive protein concentration and the vascular benefits of statin therapy: an analysis of 20,536 patients in the Heart Protection Study. Lancet 2011;377(9764):469-476.  [PMID:21277016]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Industry + govt

Allocation:
Concealed

Setting:
Population-based

Synopsis:
In the JUPITER trial, patients at high risk of vascular events with normal lipid levels and high levels of hsCRP had fewer events when treated with a statin than with placebo. In the JUPITER trial, after approximately 2 years of follow-up, all-cause mortality was lower in the rosuvastatin group (1.0 vs 1.25 per 100 patient years; P = .02) and there were fewer myocardial infarctions in the rosuvastatin group (0.17 vs 0.37 per 100 patient years; P = .0002). However, since the study was terminated early, there are concerns that those data may overinflate the real event rates. So, the authors of this study did a secondary analysis of data from the more than 20,000 men and women who participated in the Heart Protection Study (http://www.essentialevidenceplus.com/content/poem/41063). In the Heart Protection Study, patients at high risk of vascular events were randomly assigned to receive 40 mg simvastatin daily or placebo and followed up for a median of 5 years. The patients taking simvastatin had 1.8% fewer deaths from any cause and 1.5% fewer cardiovascular events, regardless of initial lipid levels. These researchers went back to the original blood samples and assessed the hsCRP levels for each patient. They categorized each patient into 6 groups based on the hsCRP levels and re-analyzed the outcomes. Ultimately, the hsCRP levels did not seem to predict a benefit to statins for major vascular events, major coronary events, stroke, revascularization, or death.

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