scholarly journals The Clinical Utility of High-Sensitivity C-Reactive Protein in Cardiovascular Disease and the Potential Implication of JUPITER on Current Practice Guidelines

2009 ◽  
Vol 55 (2) ◽  
pp. 219-228 ◽  
Author(s):  
Samia Mora ◽  
Kiran Musunuru ◽  
Roger S Blumenthal
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
High Sensitivity ◽  
C Reactive Protein ◽  
Potential Implication ◽  
Reactive Protein ◽  
Risk Patients ◽  
Asymptomatic Individuals

Abstract Background: High-sensitivity C-reactive protein (hsCRP) testing is relatively inexpensive and has been shown to predict the risk of cardiovascular disease (CVD) and diabetes in multiple patient groups, including those treated with statin therapy. JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin) is a recently completed large multicenter randomized clinical trial that tested whether statin therapy should be given to apparently healthy individuals with lower LDL cholesterol (LDL-C) concentrations but increased hsCRP concentrations. Content: This review discusses the literature on hsCRP in asymptomatic populations, analyzes it according to CVD and diabetes, and provides summary recommendations for the use of hsCRP in clinical practice. In this context, we highlight recent data from the landmark JUPITER trial, which demonstrated that hsCRP can be used to target high-risk patients who have typical LDL-C concentrations and no known vascular disease or diabetes and who would benefit from statin use. We also summarize evidence that among patients treated with statin therapy, achieving low hsCRP concentrations may be a clinically relevant therapeutic goal along with achieving very low LDL-C concentrations. Summary: JUPITER has demonstrated that combining hsCRP testing with traditional testing of lipids can reduce incident CVD in high-risk asymptomatic individuals by 44% and all-cause mortality by approximately 20%, extending the therapeutic use of statins for the primary prevention of CVD. Guidelines for practitioners could include testing asymptomatic individuals for increased concentrations of hsCRP in men ≥50 years and women ≥60 years when LDL-C concentrations are not increased and for whom the decision to treat with statin therapy is not otherwise clear.

scholarly journals Statins for primary prevention of cardiovascular disease: modelling guidelines and patient preferences based on an Irish cohort

2019 ◽  
Vol 69 (683) ◽  
pp. e373-e380 ◽  
Author(s):  
Paula Byrne ◽  
John Cullinan ◽  
Paddy Gillespie ◽  
Rafael Perera ◽  
Susan M Smith
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
Clinical Guidelines ◽  
Baseline Risk ◽  
Recommended Treatment ◽  
Risk Patients ◽  
Very High ◽  
Prevention Of Cardiovascular Disease

BackgroundChanges in clinical guidelines for primary prevention of cardiovascular disease (CVD) have widened eligibility for statin therapy.AimTo illustrate the potential impacts of changes in clinical guidelines.Design and settingModelling the impacts of seven consecutive European guidelines based on a cohort of people aged ≥50 years from the Irish Longitudinal Study on Ageing.MethodThe eligibility for statin therapy of a sample of people without a history of CVD was established, according to changing guideline recommendations and modelled associated potential costs. The authors calculated the numbers needed to treat (NNT) to prevent one major vascular event in patients at the lowest baseline risk for which each of the seven guidelines recommended treatment, and for those at low, medium, high, and very-high risk according to 2016 guidelines. These were compared with the NNT that patients reported as required to justify taking a daily medicine.ResultsThe proportion of patients eligible for statins increased from approximately 8% in 1987 to 61% in 2016; associated costs rose from €13.9 million to €107.1 million per annum. The NNT for those at the lowest risk for which each guideline recommended treatment rose from 40 to 400. By 2016, the NNT for low-risk patients was 400 compared to ≤25 very-high risk patients. The proportion of patients eligible for statins achieving NNT levels that patients regarded as justified to taking a daily medicine fell as guidelines changed over time.ConclusionIncreased eligibility for statin therapy impacts large proportions of the present population and healthcare budgets. Decisions to take and reimburse statins should be considered on the basis of expected cost-effectiveness and acceptability to patients.

The Role of Suppressing Inflammation in the Treatment of Atherosclerotic Cardiovascular Disease

2020 ◽  
Vol 54 (10) ◽  
pp. 1021-1029
Author(s):  
Yuani M. Roman ◽  
Adrian V. Hernandez ◽  
C. Michael White
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
English Language ◽  
Atherosclerotic Cardiovascular Disease ◽  
C Reactive Protein ◽  
High Risk Patients ◽  
Reactive Protein ◽  
Risk Patients ◽  
Hs Crp ◽  
The Impact

Objective: To review the 3 anti-inflammatory drugs, canakinumab, colchicine, and methotrexate, that have been investigated in major clinical trials for treating patients with atherosclerotic cardiovascular disease (ASCVD). Data Sources: An Ovid MEDLINE literature search (1946 to February 2, 2020) was performed using search strategy [( C-reactive protein OR ASCVD OR cardiac disease OR cardiovascular disease) AND (canakinumab OR methotrexate OR Colchicine)]. Additional references were identified from the citations. Study Selection and Data Extraction: English-language studies assessing the impact of these 3 drugs on inflammation as measured by high-sensitivity C-reactive protein (hs-CRP) or the association with reducing ASCVD events were included. Data Synthesis: Canakinumab and colchicine significantly reduced ASCVD events in high-risk patients with median baseline hs-CRP levels of ~4.0 mg/L. Methotrexate was ineffective at reducing ASCVD events in high-risk patients, but their baseline hs-CRP concentrations were a median of <2 mg/L. In subgroup analyses of the Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS), patients whose baseline hs-CRP was 2 to 4 mg/L had benefits from canakinumab therapy similar to those with baseline levels exceeding 4. Relevance to Patient Care and Clinical Practice: Even with the best current drug therapies, patients with underlying inflammation can benefit from the addition of both colchicine and canakinumab to further lower CV events. Given its cost, colchicine is a more attractive option. Conclusions: Patients at high risk of recurrent cardiovascular disease events with an hs-CRP of 2 mg/L or greater can reduce the occurrence of ASCVD events with canakinumab or colchicine therapy. Colchicine is the preferable option, in particular for those with myocardial infarction, given its more reasonable cost.

scholarly journals Risk classification in primary prevention of CVD according to QRISK2 and JBS3 ‘heart age’, and prevalence of elevated high-sensitivity C reactive protein in the UK cohort of the EURIKA study

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000849 ◽  
Author(s):  
Ieuan Johns ◽  
Konstantinos E Moschonas ◽  
Jesús Medina ◽  
Nicholas Ossei-Gerning ◽  
George Kassianos ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Sensitivity ◽  
Low Risk ◽  
Chronological Age ◽  
C Reactive Protein ◽  
Cvd Risk ◽  
Treatment Threshold ◽  
Reactive Protein ◽  
Risk Patients ◽  
Heart Age

ObjectivesThis study assessed cardiovascular disease (CVD) risk classification according to QRISK2, JBS3 ‘heart age’ and the prevalence of elevated high-sensitivity C reactive protein (hsCRP) in UK primary prevention patients.MethodThe European Study on Cardiovascular Prevention and Management in Usual Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted in 12 European countries. 673 UK outpatients aged ≥50 years, without clinical CVD but with at least one conventional CVD risk factor, were recruited. 10-year CVD risk was calculated using QRISK2. JBS3 ‘heart age’ and hsCRP level were assessed according to risk category.ResultsQRISK2 and JBS3 heart age was calculated for 285 of the 305 patients free from diabetes mellitus and not receiving a statin. QRISK2 classified 28%, 39% and 33% of patients as low (<10%), intermediate (10% to <20%) and high (≥20%) risk, respectively. Two-thirds of low-risk patients and half of intermediate-risk patients had a heart age ≥5 years and ≥10 years higher than their chronological age, respectively. Half of low-risk patients had hsCRP levels ≥2 mg/L and approximately 40% had levels ≥3 mg/L. Approximately 80% of low-risk patients had both elevated hsCRP and heart age relative to their chronological age.ConclusionsAlmost 40% more patients in this ‘at risk’ group would be eligible for statin therapy following the lowering of the National Institute for Health and Care Excellence treatment threshold to ≥10% 10-year risk. Of patients falling below this treatment threshold, almost all were at increased lifetime risk as measured by JBS3, and of these, the majority had elevated hsCRP levels. These patients with high absolute risk may benefit from early primary CVD prevention.

JUPITER – Exploring New Frontiers

2009 ◽  
Vol 5 (2) ◽  
pp. 28
Author(s):  
Peter J Lansberg ◽  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
High Sensitivity ◽  
Hs Crp ◽  
Current Guidelines

Over the last two decades statins have become indispensable for managing patients at high risk of cardiovascular disease. Since their introduction in the late 1980s, their role has expanded from drugs to be used in secondary prevention to standard treatment in primary prevention for individuals at high risk of cardiovascular disease. Targets for low-density lipoprotein (LDL) cholesterol, as well as LDL levels at which statin therapy should be started, have gradually gone down. The JUPITER study succeeded in expanding the limits of earlier interventions and aimed for lower plasma LDL cholesterol levels, as well as including high-sensitivity C-reactive protein (hs-CRP) as a biomarker for risk and target for treatment. The investigators included patients who, according to current guidelines, would not qualify for statin therapy. Patients with elevated levels of hs-CRP (>2mg/dl) and low LDL cholesterol (<130mg/dl) were treated with rosuvastatin 20mg or placebo. The trial was terminated after 1.9 years because of unexpected early benefits, whereby the relative risk of developing atherothrombotic complications was reduced by 44%. The implications of this trial are far-reaching, not only because of the public health consequences of treating a larger number of individuals with aggressive statin therapy than current guidelines dictate; it also forces us to re-evaluate current cardiovascular risk calculating tools. The provocative results of this important primary prevention trial have generated new questions on how to intervene earlier in the development of atherosclerosis in patients at risk of cardiovascular disease.

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