New data reveals that inflammation is a stronger predictor of future cardiovascular events and death than cholesterol among patients who take statins, suggesting that treatment regimens that target both LDL and vascular inflammation are more likely to reduce atherosclerotic risk compared to treatments that only target LDL.
The Lancet meta-analysis used 32k patients’ data from the PROMINENT, REDUCE-IT, and STRENGTH trials, all of whom had or were at high risk of ASCVD and were already taking statins. Across the three trial groups, baseline levels of high-sensitivity CRP (hsCRP) and LDL-C were “almost identical.” The study was also authored by leaders of the three original trials.
After adjustments, comparisons of patients in the highest and lowest hsCRP quartiles seemed to solidify residual inflammatory risk’s association with:
- Major adverse cardiovascular events (HR: 1.31)
- Cardiovascular mortality (HR: 2.68)
- All-cause mortality (HR: 2.42)
Meanwhile, patients in the highest and lowest LDL-C quartiles revealed that residual cholesterol risk had a “neutral” association with MACE and a “low magnitude” associated with mortality:
- Major adverse cardiovascular events (HR: 1.07)
- Cardiovascular mortality (HR: 1.27)
- All-cause mortality (HR: 1.16)
We’ve seen growing evidence that patients on statins can benefit from adjunctive LDL-lowering therapies, but this study gives a strong argument for combining LDL-reducing and inflammation-reducing therapies. If proven through future trials, that could have a major impact on ASCVD care.