Statins' Role in Protecting Against Heart Attack is
Significantly Expanded by New Studies
HsCRP is one of the most widely studied markers of
inflammation in cardiovascular disease: statement from the director of
National Heart, Lung, and Blood Institute
Nov. 11, 2008 – A new term that every senior
citizen should remember is “high-sensitivity C-reactive protein (hsCRP).”
This is the new protein indicator of inflammation that can be detected
by a simple blood test and warns of heart disease. The discovery guides
treatment that can significantly lower the risk of heart attack, stroke,
and death.
The importance of this discovery is highlighted in
the following statement yesterday by Elizabeth G. Nabel, M.D., Director,
National Heart, Lung, and Blood Institute, which funded much of the
research.
New Findings on the Role of Inflammation in
Prevention of Coronary Heart Disease
“This year, about 450,000 Americans will die of
coronary heart disease - the leading cause of death for both men and
women. Although we have made great strides in preventing and treating
heart disease, we continue to explore the complex mechanisms involved in
cardiovascular disease, and we are eager to refine risk assessment tools
and preventive strategies to reduce the incidence of heart attack and
stroke.
“New results from three studies being presented at
the American Heart Association (AHA) Scientific Sessions in New Orleans
and published in scientific journals today provide the strongest
evidence to date that a simple blood test for high-sensitivity
C-reactive protein (hsCRP) is a useful marker for cardiovascular
disease.
“Importantly, a much-anticipated study demonstrates
for the first time that hsCRP levels in the blood can be used to guide
treatment decisions to effectively lower the risk of heart attacks,
stroke, and death. Together, these studies show great promise in helping
clinicians better identify and treat individuals at risk for
cardiovascular disease - potentially saving millions more lives.
“For years, growing evidence has suggested that
inflammation plays a strong role in developing cardiovascular disease,
especially atherosclerosis, or hardening of the arteries. HsCRP is one
of the most widely studied markers of inflammation in cardiovascular
disease.
“But, whether measuring hsCRP adds any measurable
value for predicting risk for cardiovascular disease independent of
traditional risk factors, such as age, blood cholesterol levels, blood
pressure, diabetes, and smoking has been a topic of great debate.
Further, it has been uncertain whether hsCRP levels can be used to
improve treatment decisions.
“Two studies supported by the National Heart, Lung,
and Blood Institute (NHLBI) show that adding hsCRP levels to assess risk
of a first heart attack or stroke in middle-aged or older adults
improves accuracy over the traditional assessment tools by between 5
percent and 14 percent.
“The information proved to be especially valuable
in reclassifying the risk of heart disease and stroke among individuals
considered to be at intermediate risk (10 percent to 20 percent risk of
having a heart attack within 10 years) by traditional methods.
“Using data from the 3006 participants in NHLBI's
Framingham Heart Offspring Study, Peter W. F. Wilson, M.D., of Emory
University in Atlanta and colleagues from NHLBI, Boston University, and
Tufts USDA Nutrition Center in Boston found that using hsCRP levels to
assess risk provided a more accurate risk assessment over traditional
risk scores among people otherwise considered at intermediate risk.
“The researchers suggest a two-stepped approach to
assessing risk - using traditional risk scores first, then adding hsCRP
levels to those found to be at intermediate risk - to guide clinical
decisions. These results are published online today in Circulation
Cardiovascular Quality and Outcomes.
“In the second study, researchers used data from
10,724 men in the Physicians Health Study-II to prospectively develop
the Reynolds Risk Score for Men, which adds hsCRP levels and parental
history of early heart disease to traditional risk factors to assess
men's risk.
"The new assessment tool was significantly more accurate than
traditional risk factors alone in the study population. The report, by
Paul Ridker, MD, of Brigham and Women's Hospital and Harvard Medical
School in Boston, and colleagues, is published online in the journal
Circulation today and will be presented Tuesday at the AHA
Scientific Sessions. Previous work in the NHLBI-funded Women’s Health
Study led to the development of a comparable Reynolds Risk Score for
women last year.
“The third hsCRP study results released today are
from JUPITER (the Justification for Use of statins in Prevention: an
Intervention Trial Evaluating Rosuvastatin), an international randomized
clinical trial to test the effectiveness of treating individuals with
high levels of hsCRP. Dr. Ridker and his colleagues demonstrate for the
first time that a strategy of treatment decisions based upon hsCRP
levels in otherwise healthy individuals significantly improves outcomes.
“The study of 17,802 apparently healthy men and
women was stopped early on March 30 after about 2 years because of the
strong positive results. The researchers found that a daily dose of a
commonly used statin, rosuvastatin (Crestor), reduced the risk of heart
attack, stroke, and death by nearly half (44 percent) in individuals
with high levels of hsCRP (2.0 mg/L or higher) but with normal or low
levels of LDL (130mg/dL or lower).
"The treatment reduced LDL cholesterol by 50
percent and hsCRP by 37 percent.
"Supported by AstraZeneca, U.S., the study was
presented today at the AHA Scientific Sessions and appears online in the
New England Journal of Medicine (November 20, 2008, print issue).
“These studies expand our understanding of the role
of inflammation in detecting early signs of cardiovascular disease and
identifying adults who are at risk for heart attack or stroke. These
findings suggest that adding hsCRP levels to traditional risk factors
could identify millions more adults for whom treatment with statins
appears to lower the risk of heart attack.
“Many clinicians now offer hsCRP testing to their
patients, but until now the value of hsCRP levels to treatment
decisions, especially in adults with desirable cholesterol levels, was
unclear. As with any medical discovery, however, broadly adopting a new
approach to detect or treat a condition should first be critically
tested, preferably through large-scale event-based randomized clinical
trials like JUPITER, and proven to bear greater benefits than risks,
including costs.
“As part of the NHLBI strategic plan, we have
engaged an expert panel to review and update the scientific evidence
regarding the assessment and management of cardiovascular risk factors.
Today’s findings will
be part of the rigorous scientific review to distill the scientific
evidence and generate an evidence-based, comprehensive, set of clinical
guidelines for primary care practitioners to help adult patients reduce
their risk for cardiovascular disease.
“In the meantime, however, we must not lose sight
of the essential truth of what we already know to prevent heart disease:
Cholesterol still counts, and we have proven ways to lower it and lessen
its impact. The value of following a heart-healthy eating plan, being
physically active, maintaining a healthy weight, and not smoking cannot
be overestimated. And, statins can significantly reduce the risk of
heart attack in those at high risk.
“Let us continue to use our current knowledge as
well as apply new discoveries based on solid evidence to take action for
the betterment of individual and public health.
Part of the National Institutes of Health, the
National Heart, Lung, and Blood Institute plans, conducts, and supports
research related to the causes, prevention, diagnosis, and treatment of
heart, blood vessel, lung, and blood diseases; and sleep disorders. The
Institute also administers national health education campaigns on women
and heart disease, healthy weight for children, and other topics. NHLBI
press releases and other materials are available online at
www.nhlbi.nih.gov.
The National Institutes of Health (NIH) — The
Nation's Medical Research Agency — includes 27 Institutes and Centers
and is a component of the U.S. Department of Health and Human Services.
It is the primary federal agency for conducting and supporting basic,
clinical and translational medical research, and it investigates the
causes, treatments, and cures for both common and rare diseases. For
more information about NIH and its programs, visit
www.nih.gov.
Keep up with the latest news for senior citizens, baby
boomers
Nov. 11, 2008 – A new term that every senior
citizen should remember is “high-sensitivity C-reactive protein (hsCRP).”
This is the new protein indicator of inflammation that can be detected
by a simple blood test and warns of heart disease. The discovery guides
treatment that can significantly lower the risk of heart attack, stroke,
and death.
Nov.
10, 2008