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Statins and serum markers for CV disease

 

Clinical bottom line

Of the seven serum markers examined, a significant change with statin was found only for C-reactive protein. There are indications that high levels of C-reactive protein predict poor cardiovascular prognosis. These findings suggest that statin-mediated anti-inflammatory effects may contribute to how statins reduce risk of cardiovascular disease.


Reference


EM Balk et al. Effects of statins on nonlipid serum markers associated with cardiovascular disease. A systematic review. Annals of Internal medicine 2003 139: 670-682.


Background

Statins are known to affect serum lipids by reducing LDL cholesterol and increase HDL cholesterol. Other serum markers for cardiovascular disease exist, and statins may affect them also. This systematic review set out to explore that possibility.

Systematic review

The systematic review searched the English-language literature using MEDLINE between 1980 and November 2002, updated in June 2003. Reviews and bibliographies were also searched. Seven outcomes of interest were pre-set: C-reactive protein, fibrinogen, homocysteine, LDL cholesterol oxidation, tissue plasminogen activator, plasminogen activator inhibitor, and platelet aggregation. Placebo-controlled and cohort studies were used.

Results

The searches found 104 papers with information. They examined five different statins at different doses, they varied widely in duration, and included different populations. Outcomes of interest to the meta-analysis were of secondary interest in the original studies.

Of the seven serum markers, a significant change with statin was found only for C-reactive protein. In studies comparing statin with placebo, patients with statin had a greater reduction of C-reactive protein than those receiving placebo. The percentage reduction was 13% to 50%, and the absolute change was 0 to -3.1 mg/L. There was no obvious difference between the statins.

Comment

C-reactive protein is an acute phase reactant produced in the liver and thought to represent an integrated assessment of the overall state of activation of the inflammatory system. There are indications that high levels of C-reactive protein predict poor cardiovascular prognosis. These findings suggest that statin-mediated anti-inflammatory effects may contribute to how statins reduce risk of cardiovascular disease.