Lipid-lowering agents reduce risk for CV events, but not inflammation
CHICAGO – Agents that decrease LDL cholesterol levels also reduce the risk for major adverse CV events, though they do not limit inflammation that may lead to these events, according to findings presented at American Heart Association Scientific Sessions.
“Statins, PCSK9 inhibitors and ezetimibe have all been shown to reduce major adverse CV events, owing to [a] reduction in LDL cholesterol,” the researchers wrote. “There has been an increasing interest [in] targeting inflammation to reduce major adverse CV events in patients with known or increased risk [for] coronary artery disease.”
The aim of the current study was “to determine whether contemporary lipid-lowering therapy in the form of statins or PCSK9 inhibition is associated with a discernible reduction in inflammation as measured by the levels of high-reactivity C-reactive protein.”
Haris Riaz, MD, a fellow at the Cleveland Clinic, and colleagues searched the PubMed, Embase and CENTRAL databases to identify randomized controlled clinical trials that compared statins and PCSK9 inhibitors with placebo or active control groups. All trials selected by the researchers reported rates of major adverse CV events and high-reactivity CRP (as mg/L).
Thirteen randomized controlled trials, including nine with statins and four with PCSK9 inhibitors, were selected from an initial review of 1,362 records. Meta analyses did not reveal substantial differences in high-reactivity CRP levels with high-dose statins when compared with placebo or low-dose statins (standard mean difference, –0.016; 95% CI, –0.099 to 0.066), regardless of a considerable decrease in major adverse CV events across all stratified high-reactivity CRP levels (HR = 0.81; 95% CI, 0.72-0.91). There was also no difference observed in high-reactivity CRP levels with treatment among patients in the PCSK9 trials (standard mean difference, 0; 95% CI, –0.017 to 0.017) in spite of a decrease, again, in major adverse CV events (HR = 0.86; 95% CI, 0.81-0.92).
“LDL cholesterol-lowering therapies reduce relative risk of major adverse CV events across high-reactivity CRP strata,” the researchers wrote. “However, contemporary lipid-lowering therapies do not mitigate the inflammatory risk.” - by Julia Ernst, MS
Riaz H, et al. Abstract Su1229/1229. Presented at: American Heart Association Scientific Sessions; Nov. 10-12, 2018; Chicago.
Disclosures: The researchers report no relevant financial disclosures.