Simvastatin reduced both low-density lipoprotein cholesterol and highly sensitive C-reactive protein levels in 14 days, according to an article in the August 27th rapid access issue of Circulation.

"Simvastatin caused a tremendous drop in low-density lipoprotein cholesterol in just 7 days, as we had expected, and also significantly reduced highly sensitive C-reactive protein levels in 14 days. That finding was new," says Robert H. Eckel, M.D., a co-author of the study.

"The speed with which simvastatin lowers highly sensitive C-reactive protein levels raises the question of whether statins may prove useful for the acute treatment of coronary events, much the way nitroglycerin is used in emergency rooms today," he says.

Highly sensitive C-reactive protein is a marker of inflammation, and elevated levels are a risk factor for myocardial infarction. In addition, the level of protein in the blood increases dramatically at the time of acute infarction. Recent research indicates that statins can significantly reduce levels over time, but this is the first study to find a significant decrease in just two weeks, according to Dr. Eckel.

Elevated highly sensitive C-reactive protein levels after myocardial infarction or a reperfusion procedure are associated with poor outcomes. "Perhaps we could reduce those complications by giving statins right after angioplasty in patients who otherwise did not meet the criteria for the drug," Eckel says.

In the current study, 40 men and women with high low-density lipoprotein cholesterol levels were randomly assigned to simvastatin for 14 days followed by placebo for 14 days or placebo followed by statin. The average low-density lipoprotein cholesterol level for both groups (baseline, 162 mg/dL) fell 56 mg/dL by Day 7 of statin treatment, and an additional 8 mg/dL by Day 14. Average protein levels fell from 2.55 mg/L to 1.60 mg/L by Day 14.

The drug's effect on inflammation was unrelated to its effect on cholesterol levels, indicating that simvastatin may work through multiple mechanisms. The authors also state that the results of the current study support those of earlier studies: Statins appear to protect against first and recurrent myocardial infarctions in patients with elevated levels of highly sensitive C-reactive protein regardless of cholesterol level.

Although the role of inflammation in myocardial infarction and ischemic stroke is still under debate, Eckel believes it is clear that inflammatory processes and heart disease often occur together. Testing for protein level is not standard practice, but it can be done fairly easily and cheaply.

"I wouldn't promote its use on the basis of one study, but the evidence for its usefulness is increasing over time," he says. "The results of this study may have important long-term clinical implications by changing the way physicians manage all patients, both in the acute setting and in prevention of cardiovascular disease events."