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CLINICAL STUDY: CORONARY ARTERY DISEASE

Statin therapy, lipid levels, C-reactive protein and the survival of patients with angiographically severe coronary artery disease

^a Cardiovascular Department, LDS Hospital, Salt Lake City, Utah, USA
^b University of Utah, Salt Lake City, Utah, USA

Manuscript received February 14, 2000; revised manuscript received May 8, 2000, accepted July 11, 2000.

Reprint requests and correspondence: Dr. J. Brent Muhlestein, Department of Cardiology Research, LDS Hospital, 8th Avenue & C Street, Salt Lake City, Utah 84143
ldbmuhle{at}ihc.com

OBJECTIVES

The joint predictive value of lipid and C-reactive protein (CRP) levels, as well as a possible interaction between statin therapy and CRP, were evaluated for survival after angiographic diagnosis of coronary artery disease (CAD).

BACKGROUND

Hyperlipidemia increases risk of CAD and myocardial infarction. For first myocardial infarction, the combination of lipid and CRP levels may be prognostically more powerful. Although lipid levels are often measured at angiography to guide therapy, their prognostic value is unclear.

METHODS

Blood samples were collected from a prospective cohort of 985 patients diagnosed angiographically with severe CAD (stenosis 70%) and tested for total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and CRP levels. Key risk factors, including initiation of statin therapy, were recorded, and subjects were followed for an average of 3.0 years (range: 1.8 to 4.3 years) to assess survival.

RESULTS

Mortality was confirmed for 109 subjects (11%). In multiple variable Cox regression, levels of TC, LDL, HDL and the TC:HDL ratio did not predict survival, but statin therapy was protective (adjusted hazard ratio [HR] = 0.49, p = 0.04). C-reactive protein levels, age, left ventricular ejection fraction and diabetes were also independently predictive. Statins primarily benefited subjects with elevated CRP by eliminating the increased mortality across increasing CRP tertiles (statins: HR = 0.97 per tertile, p-trend = 0.94; no statins: HR = 1.8 per tertile, p-trend < 0.0001).

CONCLUSIONS

Lipid levels drawn at angiography were not predictive of survival in this population, but initiation of statin therapy was associated with improved survival regardless of the lipid levels. The benefit of statin therapy occurred primarily in patients with elevated CRP.

Abbreviations and Acronyms   CAD = coronary artery disease   CI = 95% confidence interval   CRP = C-reactive protein   HDL = high-density lipoprotein   HR = hazard ratio   LDL = low-density lipoprotein   LVEF = left ventricular ejection fraction   MI = myocardial infarction   TC = total cholesterol

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