Key Points:<\/p>\n
<\/p>\n
Inflammation is a critical component of cardiometabolic risk. \u00a0Among statin-users, randomized trial data demonstrate that adjunctive LDL-lowering therapy and adjunctive inflammation inhibition further reduce risk, but it is unclear whether clinicians should choose a second LDL-lowering agent for those already treated with a statin or alternatively choose an anti-inflammatory agent. In a breaking presentation at the 2023 ACC Conference today, Dr. Paul Ridker (Brigham and Women\u2019s) and his team presented their study: \u201cRelative Importance of Inflammation and Cholesterol as Determinants of Residual Cardiovascular Risk among 31,245 Contemporary Statin Treated Patients.\u201d<\/p>\n
The authors undertook a collaborative analysis of patients with\u2014or at high risk of\u2014atherosclerotic disease, including participants in the multinational PROMINENT REDUCE-IT, or STRENGTH trials. This study was designed to assess the relationships of hsCRP (a biomarker for residual inflammatory risk) and LDL-C\u00a0 with the incidence of MACE, CV mortality, and all-cause mortality among 31,245 statin-treated patients with or at high risk for future atherosclerotic disease. Statin treated participants in PROMINENT (N = 9,988), REDUCE-IT (N = 8,179) and STRENGTH (N = 13,078) were included. All analyses were adjusted for age, gender, BMI, smoking, blood pressure, history of CVD, and randomized treatment assignment. The primary endpoints included incident MACE, CV mortality, and all-cause mortality during trial follow-up (3 to 5 years).<\/p>\n
In total 31,245 patients were analyzed; the average age was 64, and approximately 30% were women. The average BMI was 32. In primary analysis, both hsCRP (aHR 1.31, p < 0.0001) and LDL-C (aHR 1.07, p < 0.05) \u00a0were related to incident MACE. When evaluated by quartile, hsCRP quartiles 3 and 4 (representative of high residual inflammatory risk) were both associated with incident MACE (aHR 1.17, 95% CI 1.07-1.28, p=0.001 for quartile 3 and aHR 1.31, 95% CI 1.20-1.43, p < 0.0001 for quartile 4), but no quartile of LDL-C had a significant association. hsCRP Quartiles 2-4 and LDL-C quartile 4 were associated with increased all-cause mortality and CV mortality, separately. On interaction analysis, hsCRP > 2mg\/L was significantly associated with increased MACE regardless of LDL-C value (p < 0.0001 for both), but there was no significant association when hsCRP was <2mg\/L regardless of LDL-C category.<\/p>\n
When discussing the clinical implications of the study at ACC, Dr. Ridker stated: \u201cAmong contemporary statin-treated patients, residual inflammatory risk as assessed by hsCRP was a stronger determinant of risk for future cardiovascular events and death than residual cholesterol risk as assessed by LDL-C\u2026 in all three trials, individuals with elevated hsCRP were at high cardiovascular risk irrespective of LDL-C level\u2026 while these data must not be construed to diminish the proven and crucial role of adjunctive lipid-lowering for those with persistent or refractory hypercholesterolemia, they do suggest that targeting of LDL-C alone is unlikely to completely reduce atherosclerotic risk and that inflammatory pathways have yet to be fully exploited to reduce fatal and nonfatal CV events.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
Key Points: Both inflammatory risk and hyperlipidemia and crucial risk factors for MACE in patients at high risk of CVD. In a large collaborative study of patients combining data from the PROMINENT (N = 9,988), REDUCE-IT (N = 8,179) and STRENGTH (N = 13,078) trials, the effect of residual inflammatory risk (as measured by hsCRP) […]<\/p>\n","protected":false},"author":40603,"featured_media":11007,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[878,8],"tags":[877,45,47,185],"ppma_author":[1029],"class_list":{"0":"post-137937","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-acc-2023","8":"category-news","9":"tag-acc-2023","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/137937","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=137937"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/137937\/revisions"}],"predecessor-version":[{"id":137938,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/137937\/revisions\/137938"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/11007"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=137937"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=137937"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=137937"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=137937"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}