INFLAMMATION, PRAVASTATIN, AND THE RISK OF CORONARY EVENTS AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH AVERAGE CHOLESTEROL LEVELS

Citation
Pm. Ridker et al., INFLAMMATION, PRAVASTATIN, AND THE RISK OF CORONARY EVENTS AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH AVERAGE CHOLESTEROL LEVELS, Circulation, 98(9), 1998, pp. 839-844
Citations number
34
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Peripheal Vascular Diseas",Hematology,"Cardiac & Cardiovascular System
Journal title
ISSN journal
0009-7322
Volume
98
Issue
9
Year of publication
1998
Pages
839 - 844
Database
ISI
SICI code
0009-7322(1998)98:9<839:IPATRO>2.0.ZU;2-U
Abstract
Background-We studied whether inflammation after myocardial infarction (MI) is a risk factor for recurrent coronary events and whether rando mized treatment with pravastatin reduces that risk. Methods and Result s-A nested case-control design was used to compare C-reactive protein (CRP) and serum amyloid A (SAA) levels in prerandomization blood sampl es from 391 participants in the Cholesterol and Recurrent Events (CARE ) trial who subsequently developed recurrent nonfatal MI or a fatal co ronary event (cases) and from an equal number of age- and sex-matched participants who remained free of these events during follow-up (contr ol subjects). Overall, CRP and SAA were higher among cases than contro l subjects (for CRP P=0.05; for SAA P=0.006) such that those with leve ls in the highest quintile had a relative risk (RR) of recurrent event s 75% higher than those with levels in the lowest quintile (for CRP RR =1.77, P=0.02; for SAA RR=1.74, P=0.02). The study group with the high est risk was that with consistent evidence of inflammation (elevation of both CRP and SAA) who were randomly assigned to placebo (RR=2.81, P =0.007); this risk estimate was greater than the product of the indivi dual risks associated with inflammation or placebo assignment alone. I n stratified analyses, the association between inflammation and risk w as significant among those randomized to placebo (RR=2.11, P=0.048) bu t was attenuated and nonsignificant among those randomized to pravasta tin (RR=1.29, P=0.5), Conclusions-Evidence of inflammation after MI is associated with increased risk of recurrent coronary events. Therapy with pravastatin may decrease this risk, an observation consistent wit h a nonlipid effect of this agent.