In this presentation Dr. Muhlestein presents longitudinal data from the LDS Hospital in Utah, relating to CRP as a predictor of early benefit in patients with coronary artery disease receiving statin therapy.

In an initial study published by Horne et al., blood samples were drawn from a prospective cohort of 985 patients with severe CAD, who were followed for an average of 3 years. It was found that initiation of statin therapy was associated with improved survival regardless of the lipid levels, and that statin treatment benefited primarily those patients with elevated CRP levels, by eliminating the increasing mortality across CRP tertiles (1).

Can CRP levels predict the time course of clinical benefit from statin therapy in patients with CAD? This was investigated in a study of 2,924 patients with CAD, with a follow-up of about 2 and ½ years. 29% of patients received a statin prescription at hospital discharge. Patients receiving statin treatment had better survival than those who were not, and interestingly, the tertiles of CRP were each associated with a different timepoint at which the survival benefit of statin treatment could first be observed (2).

These data support previous evidence of anti-inflammatory effects of statins, and Dr. Muhlestein discusses the implications of these and other studies on statin therapy in patients with CAD.

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

- The role of inflammation in heart disease
- Inflammatory markers and risk of future CHD events
- CRP as a predictor of future events in CAD patients
- Effect on mortality of statins based on CRP levels in patients with CAD
- CRP as a predictor of early benefit in CAD patients on statin therapy

1. Horne BD, Muhlestein JB, Carlquist JF, Bair TL, Madsen TE, Hart NI, Anderson JL.Statin therapy, lipid levels, C-reactive protein and the survival of patients with angiographically severe coronary artery disease Journal of the American College of Cardiology. Volume 36, Issue 6 , 15 November 2000, Pages 1774-1780.

2. Muhlestein JB, Anderson JL, Horne BD, Carlquist JF, Bair TL, Bunch TJ, Pearson RR; Intermountain Heart Collaborative Study Group.Early effects of statins in patients with coronary artery disease and high C-reactive protein. Am J Cardiol. 2004 Nov 1;94(9):1107-12.