Abstract 14207: C-Reactive Protein and Lipid Levels to Predict the Risk of Coronary Heart Disease in Statin-Treated Stable Coronary Patients: Prospective Results From the Treating to New Targets (TNT) Study
Background: Studies have shown that, individuals with elevated C-reactive protein (CRP) levels may be at increased cardiovascular disease (CVD) risk independently of plasma levels of low-density lipoprotein cholesterol (LDL-C). In addition, several studies have shown that the apolipoprotein B/apolipoprotein A-I (apoB/apoA-I) ratio performs better than LDL-C in predicting cardiovascular risk. Whether CRP levels add to the predictive value of the apoB/apoA-I ratio in statin-treated patients with stable coronary heart disease (CHD) is unknown.
Methods and Results: We performed a nested case-control study in the TNT (Treating to New Targets) study population, a randomized trial that compared the efficacy of high (80mg) vs. low (10mg) dose atorvastatin for the secondary prevention of CVD. Fasting levels of standard lipids and of CRP were obtained after an 8-week run-in period on atorvastatin 10 mg in 493 patients who experienced CVD during the 4.9 years of study follow-up and in 1013 treatment-matched controls. Compared to patients with CRP levels <2 mg/L, those with CRP levels ≥3 mg/L had an age-, sex- and treatment arm-adjusted relative risk (RR) for future CVD of 1.16 (95%CI, 0.96-1.40). Compared to patients with LDL-C <70 mg/dL, those with LDL-C levels ≥100 mg/dL had a RR for future CVD of 1.40 (0.89-2.21). Compared to patients with an apoB/apoA-I ratio <0.8, those with an apoB/apoA-I ratio ≥1.0 had a RR for future CVD of 1.98 (1.54-2.55). Finally, compared to patients with CRP <2 mg/L and apoB/apoA-I ratio <0.8, those with CRP ≥2 mg/L and apoB/apoA-I ratio <0.8 had a RR of 1.00 (0.77-1.30), while those with CRP <2 mg/L and apoB/apoA-I ratio ≥0.8 had a RR of 1.63 (1.28-2.07) and those with CRP ≥2 mg/L and apoB/apoA-I ratio ≥0.8 had a RR of 1.80 (1.41-2.31).
Conclusions: In statin-treated patients with stable CHD the apoB/apoA-I ratio is a strong predictor of incident CVD, irrespective of plasma CRP levels.
- © 2010 by American Heart Association, Inc.