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The
combined predictive value of lipid and CRP levels on mortality was evaluated in a
prospective study of 985 patients with severe coronary artery disease, defined as at least
70% stenosis in at least 1 coronary artery or a primary branch; 109 patients (11%) died
during the mean 3.0-year follow-up. In Cox regression analyses, baseline levels of total
cholesterol, LDL-C, and HDL-C and total cholesterol:HDL-C ratio were not predictive of
mortality, but CRP level was independently predictive; patients with CRP in the first
tertile (<1.2 mg/dL) had a mortality rate of 5%, compared with 13% in the second
tertile (1.2–1.7 mg/dL; p=0.0009) and 15% in the third tertile (>1.7 mg/dL;
p=0.0001). The study also evaluated the effect of statin therapy on mortality in patients
across tertiles of CRP. In patients overall, prescription of a statin was associated with
improved mortality (hazard ratio 0.39; 95% confidence interval [CI] 0.20–0.78; p=0.002);
of the 172 patients (19%) prescribed statin therapy, 63% were prescribed simvastatin, 15%
atorvastatin, 13% pravastatin, 5% lovastatin, and 4% fluvastatin. Statin therapy appeared
to eliminate the excess mortality associated with increased CRP; among patients prescribed
statin therapy, mortality was similar across CRP tertiles (hazard ratio 0.98 per tertile,
p-trend = 0.97), whereas in patients not prescribed statins, mortality increased markedly
with increasing tertiles of CRP level (hazard ratio 1.80 per tertile, p-trend <0.0001). Reference:
Horne BD, Muhlestein JB, Carlquist JF, Bair TL, Madsen TE, Hart NI, Anderson JL. Statin
therapy, lipid levels, C-reactive protein and the survival of patients with
angiographically severe coronary artery disease. J Am Coll Cardiol 2000;36:1774-1780.
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