Use of statins prior to angioplasty procedures reduces rates of myocardial infarction, recurrent stenosis, and mortality in patients with highly elevated levels of high-sensitivity C-reactive protein, according to an article in the March 25th rapid access issue of Circulation.

Albert W. Chan, M.D., MSc., and his American colleagues collected data prospectively for 1,552 patients who underwent elective percutaneous coronary intervention (angioplasty or stenting) and had high-sensitivity C-reactive protein measurements done before surgery.

The researchers found that 39.6 percent of patients used a statin before surgery (average age 64 years, 27 percent female). Generally, the patients using statins were younger, more likely to be using an angiotensin-converting enzyme inhibitor, and more likely to have a history of coronary bypass surgery, multivessel disease, or both.

Patients taking a statin had lower median C-reactive protein levels than patients who were not using a statin agent (0.40 mg/dL versus 0.50 mg/dL). Baseline protein levels were independent of cholesterol levels. Chan said, “Statins appear to have an effect that is independent of their effect on cholesterol.”

In terms of postsurgical outcome at one year, statin pretreatment was associated with reduced risk for myocardial infarction during the procedure (5.7 percent versus 8.1 percent), a lower death rate (3.4 percent versus 6.9 percent), and a lower rate of nonfatal myocardial infarction (6.3 percent versus 9.8 percent). The rate of restenosis was significantly reduced with statin therapy among patients with elevated baseline protein levels, but there was no reduction among patients with normal protein levels.

Benefit was especially marked among patients with the highest high-sensitivity C-reactive protein levels (1.11 milligrams per deciliter or higher) ---Use was associated with 40 percent lower rates of death, myocardial infarction, and revascularization at one year.

“While recent clinical studies suggest that patients with coronary heart disease should be started on a statin irrespective of their cholesterol levels, our findings suggest inflammatory status assessed by high-sensitivity C-reactive protein levels may help doctors to prescribe statin therapy more selectively in patients with high levels. This measurement may help in targeting statin therapy,” said Chan.

Chan noted that the current study does not clarify when preoperative statins should be started. He said that other studies have demonstrated lowering of protein level as early as two weeks after the beginning of therapy and suggested it may be beneficial to delay elective procedures for patients with high protein levels so that they can start statin therapy at least two weeks in advance.