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Low Baseline High-Sensitive C-Reactive Protein is Associated with Coronary Atherosclerosis Regression: Insights from
Kenji Sakata1, Tadatsugu Gamou1, Hayato Tada1
1Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine.
Insights
Baseline high-sensitivity C-reactive protein (hs-CRP) levels predict coronary plaque regression in patients receiving combined lipid- and blood pressure-lowering therapy. This finding highlights hs-CRP as a potential biomarker for treatment response in cardiovascular disease management.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Lipidology
Background:
- The Myocardial Ischemia Treated with Percutaneous Coronary Intervention and Plaque Regression by Lipid Lowering & Blood Pressure Controlling (MILLION) study showed combined atorvastatin and amlodipine therapy promotes coronary plaque regression.
- High-sensitivity C-reactive protein (hs-CRP) is implicated in atherogenesis, but its role in plaque regression with combined therapy is unclear.
Purpose of the Study:
- To investigate the association between baseline hs-CRP levels and coronary plaque regression in patients undergoing combined lipid- and blood pressure-lowering therapy.
- To determine if hs-CRP predicts plaque volume changes in response to atorvastatin and amlodipine.
Main Methods:
- 68 patients from the MILLION study with baseline and follow-up intravascular ultrasound data were stratified by hs-CRP quartiles.
- Serial measurements of lipids, blood pressure, and plaque volume changes were analyzed.
- Multiple regression analysis identified factors associated with plaque volume reduction.
Main Results:
- No significant differences in low-density lipoprotein cholesterol (LDL-C) or blood pressure changes were observed between hs-CRP groups.
- Coronary plaque volume reduction showed a linear association with baseline hs-CRP levels (p for trend <0.05).
- Baseline hs-CRP was independently associated with plaque volume change (β=0.29, p=0.022), independent of LDL-C and blood pressure changes.
Conclusions:
- Baseline hs-CRP levels are associated with the extent of coronary plaque regression in patients treated with combined lipid- and blood pressure-lowering therapy.
- hs-CRP may serve as a predictive biomarker for plaque regression in this patient population.
Aim:
The prospective, randomized, multicenter Myocardial Ischemia Treated with Percutaneous Coronary Intervention and Plaque Regression by Lipid Lowering & Blood Pressure Controlling assessed by Intravascular Ultrasonography (MILLION) study demonstrated that combined treatment with atorvastatin and amlodipine enhanced coronary artery plaque regression. Although the baseline high-sensitive C-reactive protein (hs-CRP) reportedly plays an important role in atherogenesis, few data exist regarding the relationship between hs-CRP and plaque regression in patients receiving a combined atorvastatin and amlodipine therapy.
Methods:
A total of 68 patients (male, 55; mean age, 64.2 years) with baseline and follow-up 3-dimensional intravascular ultrasound examinations in the MILLION study were stratified by baseline hs-CRP level quartiles. The serial measurements of lipid, blood pressure, and percentage changes in the plaque volume were compared between the groups, and the factors associated with the percentage change in the plaque volume were assessed.
Results:
There were no significant between-group differences in the extent of change in low-density lipoprotein cholesterol (LDL-C) or systolic and diastolic blood pressure after 18-24 months of treatment. The percentage change in the plaque volume showed a linear association with the baseline hs-CRP (p for trend ＜0.05); however, there was no correlation with changes in LDL-C or systolic and diastolic blood pressure. In the multiple regression analysis, the baseline hs-CRP level was independently associated with the percentage change in the plaque volume (β=0.29, p=0.022).
Conclusions:
Coronary plaque regression was associated with the baseline hs-CRP level in patients treated with a combined lipid- and blood pressure-lowering therapy.
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