In this presentation Dr. Ferdinand talks about cardiovascular disease in different racial/ethnic groups and new results from the ARIES (African American Rosuvastatin Investigation of Efficacy and Safety) trial.

African Americans have been found to have a higher prevalence of cardiovascular disease compared to Caucasians or Mexican Americans in the U.S. (1), and yet African Americans with coronary artery disease or acute myocardial infarction are less likely to receive appropriate cardiac procedures or therapies (2).

African Americans also exhibit higher LDL particle size compared to other racial/ethnic groups (3), suggesting that other factors besides LDL particle size may explain the increase in coronary heart disease morbidity and mortality. In the large multinational multiracial/multiethnic INTERHEART trial, it was found that factors such as abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity could account for most of the risk of myocardial infarction (4).

Recently there has been a growing interest in the inflammatory biomarker C-reactive protein (CRP) as a marker of increased risk of coronary heart disease, and as a target for lipid-lowering therapy (5,6). Of interest is that among different racial/ethnic groups, African Americans have been found to have increased CRP levels (7).

The ARIES trial looked at the percent change in LDL cholesterol, and as secondary endpoints the percent change in other lipid parameters and the percent of patients reaching ATP III goals, in over 700 African American patients with hypercholesterolemia randomized to rosuvastatin 10 or 20 mg or atorvastatin 10 or 20 mg for 6 weeks. Dr. Ferdinand reviews the study design and primary results of the trial (8).

Out of the 774 patients randomized in the ARIES trial, 708 were included in the intention-to-treat analysis and had paired CRP samples at baseline and at 6 weeks. A subgroup analysis was also performed in 502 of these patients who had CRP levels greater than or equal to 2 mg/L. Dr. Ferdinand describes the recently published CRP results in terms of baseline characteristics influencing CRP levels, and how CRP levels changed overall compared to those patients having levels of 2 mg/L or greater at baseline (9).

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After viewing this presentation the participant will be able to discuss:

- Variations in CHD risk and CRP levels among racial/ethnic groups
- ARIES trial: study design and primary results
- ARIES trial: CRP results and their clinical implications

1. American Heart Association. 2005 Heart Disease and Stroke Statistics Update.

2. Henry J. Kaiser Family Foundation. Racial/Ethnic Differences in Cardiac Care: The Weight of the Evidence. 2002.

3. Steven M. Haffner; Ralph D'Agostino, Jr; David Goff; Barbara Howard; Andreas Festa; Mohammed F. Saad; Leena Mykkänen. LDL Size in African Americans, Hispanics, and Non-Hispanic Whites: The Insulin Resistance Atherosclerosis Study Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:2234-2240.

4. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study Lancet. 2004 Sep 11-17;364(9438):937-52.

5. Paul M Ridker, M.D., Christopher P. Cannon, M.D., David Morrow, M.D., Nader Rifai, Ph.D., Lynda M. Rose, M.S., Carolyn H. McCabe, B.S., Marc A. Pfeffer, M.D., Ph.D., Eugene Braunwald, M.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) Investigators. C-Reactive Protein Levels and Outcomes after Statin Therapy N Engl J Med. 2005 Jan 6;352(1):20-8.

6. Steven E. Nissen, M.D., E. Murat Tuzcu, M.D., Paul Schoenhagen, M.D., Tim Crowe, B.S., William J. Sasiela, Ph.D., John Tsai, M.D., John Orazem, Ph.D., Raymond D. Magorien, M.D., Charles O'Shaughnessy, M.D., Peter Ganz, M.D., for the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) InvestigatorsStatin Therapy, LDL Cholesterol, C-Reactive Protein, and Coronary Artery Disease N Engl J Med. 2005 Jan 6;352(1):29-38.

7. Nathan D. Wong, PhD ; Jose Pio, BS ; Rosemary Valencia, BS. Distribution of C-Reactive Protein and Its Relation to Risk Factors and Coronary Heart Disease Risk Estimation in the National Health and Nutrition Examination Survey (NHANES) III Prev Cardiol. 2001 Summer;4(3):109-114.

8. Ferdinand K. et al.Circulation. 2004;110(suppl):III-818 [abstract 3780].

9. Ferdinand KC, Clark LT, Watson KE, Neal RC, Brown CD, Kong BW, Barnes BO, Cox WR, Zieve FJ, Isaacsohn J, Ycas J, Sager PT, Gold A; ARIES Study Group.Comparison of Efficacy and Safety of Rosuvastatin Versus Atorvastatin in African-American Patients in a Six-Week Trial Am J Cardiol. 2006 Jan 15;97(2):229-35.