Affiliation:
1. Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
2. Department of Endocrinology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
Abstract
Background
Several lipid‐lowering therapies reduce CRP (C‐reactive protein) independently of LDL‐C (low‐density lipoprotein cholesterol) reduction, but the association between
CRP
parameters and benefits from more‐intensive
LDL
‐C lowering is inconclusive. We aimed to determine whether the benefits of more‐ versus less‐intensive
LDL
‐C lowering on cardiovascular events related to baseline, achieved, or magnitude of reduction in
CRP
concentrations.
Methods and Results
PubMed,
EMBASE
, and Cochrane were searched through July 2, 2018. We included randomized controlled cardiovascular outcome trials of
LDL
‐C lowering with statins or ezetimibe. Two reviewers independently extracted study data and rated study quality. Data were analyzed using meta‐analysis and metaregression analysis. Rate ratios of mortality and cardiovascular outcomes associated with baseline, achieved, and magnitude reduction of
CRP
concentration were calculated. Twenty‐four trials were included, with 171 250 patients randomly assigned to more‐ or less‐intensive
LDL
‐C–lowering treatments. Median follow‐up duration was 4.2 years. More‐intensive
LDL
‐C lowering resulted in a significant reduction in incidences of all outcomes. Compared with less‐intensive
LDL
‐C lowering, more‐intensive
LDL
‐C lowering was associated with less reductions in myocardial infarction with a higher baseline
CRP
concentration (change in rate ratios per 1‐mg/L increase in log‐transformed
CRP
, 1.12 [95%
CI
, 1.04–1.22;
P
=0.007]), but not other outcomes. Similar risk reductions occurred for more‐ versus less‐intensive
LDL
‐C–lowering therapy regardless of the magnitude of
CRP
reduction or the achieved
CRP
level for all outcomes.
Conclusions
Baseline
CRP
concentrations might be associated with the benefits of
LDL
‐C lowering on myocardial infarction, but no other outcomes, whereas the achieved and magnitude of reduction in
CRP
did not seem to have an important association.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
9 articles.
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