Targeting C-reactive protein levels using high-dose atorvastatin before coronary artery bypass graft surgery

Statin medication exhibits pleiotropic properties, such as improvement of endothelial function.

To determine whether a high loading dose of atorvastatin prescribed before and after coronary artery bypass graft (CABG) surgery will attenuate the inflammatory response reflected in kinetic concentrations of C-reactive protein (CRP).

The individual area under the concentration-time curve (AUC) of CRP concentration was calculated for the first five days after CABG surgery and compared among three groups of patients: group A patients (n=16), who were on chronic statin therapy, were switched to an equivalent therapy of 20 mg atorvastatin daily for 120 h; group B patients (n=15), who were on chronic statin therapy, were switched to 80 mg atorvastatin daily (one dose 24 h before CABG surgery, one on the day of surgery and two further doses after surgery) followed by 40 mg/day up to 120 h after surgery; and group C patients (n=10), who were naive to statin therapy, underwent elective CABG surgery.

The three groups were comparable according to measurements of their intra- and postoperative variables, except for their mean weight. The mean (+/- SEM) AUC-CRP for group B was 13,545+/-959.9 mg/L.h, significantly smaller (P=0.01) than that for group A (17,085+/-858.4 mg/L.h). In group C (statin-naïve patients), the AUC-CRP was 16,191+/-1447 mg/L.h, which was not significantly different from groups A and B, respectively.

High loading doses of atorvastatin before CABG surgery reduced CRP concentration, expressed as AUC-CRP. This effect supports the idea that a high dose of atorvastatin is needed to attenuate the 'negative' inflammatory response. The present study also lends support to the possibility that high-dose atorvastatin positively improves post-open-heart surgery results.