Statin therapy lowers risk for recurrent myocardial infarction by decreasing blood levels of cholesterol and C-reactive protein, and physicians should monitor both to establish efficacy of treatment, according to an article in the January 6th issue of the New England Journal of Medicine.

In early 2004, results from the multi-national Pravastatin or Atorvastatin Evaluation and Infection Therapy - Thrombolysis in Myocardial Infarction (PROVE IT - TIMI 22) trial demonstrated that lowering low-density lipoprotein cholesterol to less than 70 mg per deciliter (mg/dL) helped prevent recurrent myocardial infarction and death. Now, for the first time, a pre-specified analysis to assess if lowering C-reactive protein leads to clinical benefit revealed that it is not enough to lower low-density lipoprotein cholesterol; C-reactive protein also needs to be lowered to less than 2 mg/L in order to achieve the greatest clinical benefit.

According to Eugene Braunwald, MD, Harvard Medical School professor and chairman of the TIMI Study Group, “We now have evidence that lowering C-reactive protein is as important as lowering low-density lipoprotein cholesterol for patients to reduce the risk of recurrent cardiovascular events. Physicians prescribing statin therapy need to monitor C-reactive protein levels as well as cholesterol levels if they want to get the best results for their patients.”

Based on data from 3,745 patients in the PROVE IT - TIMI 22 trial who were treated with statin therapy, clinical outcomes after myocardial infarction were linked not only to lowering low-density cholesterol, but also to lowering C-reactive levels. In fact, patients who had low C-reactive protein levels after statin treatment did significantly better than those with high C-reactive protein levels, regardless of LDL cholesterol level.

“These new data confirm the crucial role inflammation plays in heart disease,” said lead author, Paul M Ridker, MD. “The data also provide the first hard evidence that lowering C-reactive protein levels is associated with clinical benefits for our patients.”

In this study, both parameters were measured 30 days after post-infarction patients began statin therapy. Researchers found that patients who had achieved the dual targets of low levels of both substances had the lowest rates of recurrent myocardial infarction or death. Specifically, the recurrent event rates during 2.5 years of follow-up were 9.9 percent among patients with LDL cholesterol more than 70 mg per deciliter and a C-reactive protein level of more than two mg per liter but only 4.9 percent among patients with cholesterol less than 70 mg per deciliter and protein level less than two mg per liter.

Even lower event rates - 4 percent - were seen among those who were able to further reduce C-reactive protein levels to less than one mg per liter.

“We are on the threshold of viewing CRP not only as a marker for risk, but as a target for therapy,” Ridker said. “The message for patients is to reach for the ‘dual targets’ of a low cholesterol level and a low C-reactive protein level.”