Cardiovascular Diseases and Critical Care Axis
Dr. Jacques Genest is the lead researcher in a study showing that treatment with a statin in patients who have elevated levels of C-reactive protein (CRP), a biomarker of inflammation, cuts the risk of cardiovascular disease morbidity and mortality by almost half.
Acute myocardial infarction or heart attack, caused by narrowing of the arteries via atherosclerosis, is a major cause of death worldwide. Conventional risk factors are well known, and include increased age, male gender, smoking, high blood pressure, diabetes, increase in bad cholesterol (LDL), decrease in good cholesterol (HDL), physical inactivity, poor diet and obesity.
“In the past 20 years, it’s been realized that inflammation is a major component of atherosclerosis,” says Dr. Genest. “C-reactive protein is one substance that reflects increased inflammation in blood vessels and it has been associated with an increased risk of cardiovascular disease.”
However, having a marker that predicts disease doesn’t mean that the disease can be prevented. In 2002, Dr. Paul Ridker (Brigham and Women's Hospital, Boston, MA) initiated the Jupiter Study based on the hypothesis that patients who have a high CRP would be at higher risk of heart disease. These people would benefit from a class of drugs that lowers both the LDL and CRP, known as statin therapy.
To make this an unambiguous study, older patients were selected who were presenting with increased CRP but with normal LDL cholesterol. A total of 17,802 patients were randomized around the world to either receive a placebo or rosuvastatin at 20 mg per day. “Last year we learned from the Oxford based monitoring board, that the study was already so positive it would have been unethical to continue. After nearly two years of treating patients, we stopped the study because there was a 44 per cent decrease in our primary end point of death from heart disease, acute myocardial infarction, stroke, hospitalization for angina, and the need for bypass surgery or angioplasty.”
Based on these spectacular results, many guidelines around the globe will now reconsider the measurement of CRP as a new cardiovascular risk factor and make recommendations for treatment if the CRP is elevated.