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Impact of C-reactive protein on treatment of patients with cardiovascular disease
Justine Schuller Gortney1, Rhonda Martin Sanders
1Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Mercer University, Atlanta, GA 30341, USA. gortney_js@mercer.edu
Insights
C-reactive protein (CRP) indicates cardiovascular disease risk and may benefit from statin therapy, though its role in treatment monitoring requires further research. Pharmacists should consider other risk factors for statin decisions.
Area of Science:
- Cardiology
- Biochemistry
- Pharmacology
Background:
- C-reactive protein (CRP) is a marker for coronary heart disease and other conditions, linked to endothelial dysfunction and atherothrombosis.
- CRP is an independent risk marker for cardiovascular disease, comparable to low-density-lipoprotein (LDL) cholesterol in healthy individuals.
- Guidelines from the CDC and AHA address CRP's clinical and public health applications.
Purpose of the Study:
- To describe the impact of C-reactive protein (CRP) on the treatment of patients with cardiovascular disease.
- To evaluate the role of CRP in guiding statin therapy and pharmacotherapeutic monitoring.
Main Methods:
- Review of primary and secondary prevention studies on statin therapy and CRP levels.
- Analysis of atheroma ultrasound studies examining CRP reduction and atheroma volume.
- Assessment of pharmacotherapy intensity's effect on CRP and clinical outcomes.
Main Results:
- Statins can reduce CRP levels; patients with low LDL cholesterol and high CRP may benefit from statin therapy.
- CRP reduction by statins is not directly linked to lipid-lowering effects; pravastatin reduced events irrespective of CRP.
- Intensive pharmacotherapy reduced CRP more effectively than moderate therapy, but clinical outcomes were similar once target CRP was met.
- Reduced CRP levels correlated with decreased atheroma volume, independent of the statin regimen.
Conclusions:
- The precise role of CRP in the pharmacotherapeutic monitoring of statins is not fully established.
- Further research is needed to clarify CRP's utility in statin therapy.
- Pharmacists should prioritize traditional risk factors (cholesterol, medical history, lifestyle) for statin-related clinical decisions pending more data.
Purpose:
The impact of C-reactive protein (CRP) on the treatment of patients with cardiovascular disease is described.
Summary:
CRP is a marker of coronary heart disease and other disease states. Its release from the liver activates endothelial dysfunction and contributes to atherothrombosis. In healthy persons, CRP was found to be an independent risk marker for cardiovascular disease when compared with low-density-lipoprotein (LDL) cholesterol. In 2003, the Centers for Disease Control and Prevention and the American Heart Association published a statement regarding CRP's use in clinical practice and public health. In a primary prevention study, statins were shown to reduce CRP, and patients with a low concentration of LDL cholesterol and high CRP may benefit from statin therapy. The results of a secondary prevention study confirmed that CRP reduction was not related to the lipid-lowering effects of the statins and that pravastatin reduced coronary events regardless of inflammation status designated by the CRP value. Another study demonstrated that intensive pharmacotherapy was more effective than moderate therapy in reducing CRP, but it found no difference in clinical outcomes among statin regimens once the goal CRP value was attained. In atheroma ultrasound studies, a reduced CRP level was related to reductions in atheroma volume regardless of the statin regimen used.
Conclusion:
The correct use of CRP in pharmacotherapeutic monitoring of statins has not been fully elucidated. Until more data regarding CRP and statin use are available, pharmacists must continue to focus on risk factors other than CRP, such as cholesterol levels, medical history, social history, and lifestyle characteristics, when making clinical decisions regarding statin therapy.
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