Abstract 13340: Crp Lowering with High-Intensity Statin Therapy Associates with Regression of Coronary Atherosclerosis and Improved Clinical Outcomes: Insights from Saturn

Abstract

Background Anti-inflammatory effects of statins may contribute to their clinical benefit. The relationship between reductions in CRP and atheroma progression in patients treated with high-intensity statin therapy is less well established.

Methods SATURN compared the rate of coronary atherosclerosis progression with serial intravascular ultrasonography in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg daily for 24-months. Associations between changes and achieved levels of CRP with disease progression and cardiovascular events (death, MI, CVA, coronary revascularization, hospitalization for unstable angina) were investigated in the combined treatment group.

Results In the 1039 treated patients, baseline mean LDL-C was 120±28 mg/dL and median CRP was 1.6 mg/L (interquartile range 0.8, 3.5). High-intensity statin therapy resulted in lowering of LDL-C to 65.6 mg/dL and CRP to 1.0 mg/L, with 63% of patients demonstrating a decrease in CRP. Controlling for baseline levels, the correlation between change in CRP and change in LDL-C was 0.09 (p=0.005). Patients with above median on-treatment CRP levels (1.2 mg/L) were more likely to be obese (BMI 30.2±6.0 vs 27.9±4.0, p<0.001), hypertensive (74% vs 67%, p=0.02), diabetic (19% vs 12%, p=0.002) and active smokers (38% vs 27%, p<0.001). Patients whose CRP levels decreased demonstrated a greater increase in apoA-I (14% vs 11%, p=0.02) and greater decreases in both LDL-C (44% vs 41%, p=0.02) and apoB:apoA-I ratio (37% vs 33%, p<0.001). Regression of percent atheroma volume was observed in patients with CRP-lowering, but not in those with static/increasing CRP levels (-1.44% vs -0.13%, p=0.008). On multivariable analysis, an increase in CRP independently associated with a greater likelihood of disease progression [OR 1.2 (1.06, 1.4), p=0.005]. Patients achieving a CRP level greater than the median were more likely to experience a cardiovascular event (8.0% vs 4.8%, p=0.04).

Conclusion CRP lowering with high-intensity statin therapy associates with regression of coronary atherosclerosis and improved clinical outcomes. These findings support a role of inflammation in progression of coronary artery disease, and the benefits of interventions that reduce inflammation.