Effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on high-sensitivity C-reactive protein levels.

Cardiovascular disease is the leading cause of death among adults in the United States, in Europe, and in much of Asia. Despite advances in primary prevention of coronary artery disease, including early detection and treatment of dyslipidemia, one half of all myocardial infarctions and strokes occur in patients with normal serum cholesterol levels. Observations like this prompt the search for new risk factors and improved identification of individuals at high risk. One proposed risk factor is an elevated level of C-reactive protein (CRP), a marker of inflammation independent of other risk factors. The CRP assay is desirable in terms of standardization and cost. The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are indicated for the treatment of dyslipidemias, but data support their protective role against cardiovascular disease beyond their effects on lipids. Statins directly affect inflammatory markers, and nearly 2 dozen randomized studies have demonstrated statins' effects on CRP. Because information regarding the role of CRP in cardiovascular disease is compelling but sometimes contradictory and because the need to reduce CRP levels is unclear, the American Heart Association and the Centers for Disease Control and Prevention presented a panel statement on the topic. Ongoing trials will assist in determining the need to reduce CRP levels to lower cardiovascular risk. An understanding of these issues is important for improving the prediction of cardiovascular risk and for intervening to reduce this risk.