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ASCOT: C-reactive protein screening produced no significant improvements in CVD assessment

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American Heart Association Scientific Sessions 2010

CHICAGO — High-sensitivity C-reactive protein was not found to be useful in improving risk factor prediction of cardiovascular outcomes in patients with hypertension, according to late-breaking clinical trial data.

The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) included 9,098 adults with hypertension who were randomly assigned to either calcium channel-blocker or beta-blocker treatment. Further, 4,853 patients who had less than 6.5 mmol/L total cholesterol were randomized to atorvastatin (Lipitor, Pfizer) or placebo.

At 6 months, researchers found that atorvastatin reduced LDL by 40.3% and median high-sensitivity C-reactive protein (hsCRP) by 27.4%. Among those assigned to atorvastatin, LDL lower than the median (2.1 mmol/L) correlated with a significant reduction in CV events vs. patients with LDL at or above the median.

Conversely, hsCRP levels in patients assigned to atorvastatin were not associated with CV events (OR=0.86; 95% CI, 0.49-1.51) when researchers compared patients with less than the median hsCRP (1.83 mg/L) with those having at least the median hsCRP.

At a press conference, Peter Sever, FRCP, professor of clinical pharmacology and therapeutics, Imperial College London and study investigator, said of the study, “neither baseline nor on-treatment CRP provide any useful information about the efficacy of statin treatment to reduce CV events beyond LDL cholesterol reduction. These results do not support current proposals to measure CRP in the clinical setting either to assign statins to individuals on the basis of an elevated CRP alone or to monitor CRP levels as an indicator of the efficacy of statin treatment.” – by Brian Ellis

While this is a post-hoc study, it adds to the large body of literature suggesting minimal clinical utility for CRP in risk assessment and decision making on who should go on lipid-lowering therapies, and a small and growing and frankly mixed literature examining the utility of on-treatment CRP levels.

– Donald M. Lloyd-Jones, MD

Northwestern University Feinberg School of Medicine, Chicago

For more information:

• Sever PS. LBCT IV: Abstract 21685. Presented at: American Heart Association Scientific Sessions 2010; Nov. 13-17, 2010; Chicago.

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