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High-sensitivity C-reactive protein and clopidogrel treatment in patients at high risk of cardiovascular events: a

Michael Weber1, Deepak L Bhatt, Danielle M Brennan

  • 1Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany. m.weber@kreiskliniken-dadi.de

Heart (British Cardiac Society)
|March 12, 2011
PubMed

Insights

Clopidogrel treatment reduced cardiovascular events only in patients with low high-sensitivity C-reactive protein (hsCRP) levels. This antiplatelet therapy did not affect inflammatory markers in high-risk patients.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • Atherothrombotic events pose a significant risk in patients with established atherosclerotic disease or multiple cardiovascular risk factors.
  • High-sensitivity C-reactive protein (hsCRP) is a marker of inflammation and a predictor of cardiovascular events.
  • The efficacy of clopidogrel in reducing atherothrombotic events in diverse patient populations requires further elucidation, particularly concerning its interaction with inflammatory markers.

Purpose of the Study:

  • To investigate the impact of clopidogrel treatment on hsCRP levels, an indicator of inflammation, in high-risk patients.
  • To determine if hsCRP levels predict treatment benefit from clopidogrel in preventing atherothrombotic events.
  • To assess the effect of clopidogrel plus aspirin versus placebo plus aspirin on cardiovascular outcomes.

Main Methods:

  • The CHARISMA trial enrolled 8021 patients with established atherosclerotic disease or cardiovascular risk factors.
  • Participants were randomized to receive either clopidogrel plus aspirin or placebo plus aspirin.
  • HsCRP levels were measured at baseline and study termination (median 28 months); the primary endpoint was a composite of myocardial infarction, stroke, or cardiovascular death.

Main Results:

  • A stepwise increase in the primary composite endpoint event rate was observed with increasing baseline hsCRP quartiles.
  • Changes in hsCRP levels over time were similar between the clopidogrel and placebo groups.
  • Clopidogrel demonstrated a significant reduction in cardiovascular events compared to placebo in patients with low hsCRP levels (<3 mg/l), but not in those with high hsCRP levels.

Conclusions:

  • HsCRP is a potent predictor of ischemic events in a broad population of high-risk patients.
  • Clopidogrel treatment did not alter inflammatory markers (hsCRP) compared to placebo.
  • The cardiovascular benefits of clopidogrel in this study were confined to patients with low baseline hsCRP levels, suggesting a potential role for inflammation in modulating treatment response.
Abstract

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