Results of a pooled analysis of 3 trials for high-risk patients
Higher risk increases than LDL-C
Analysis showed that the inflammatory marker (CRP) was a more powerful predictor of cardiovascular accidents than the LDLC-C (cholesterol) level.
A research team at Brigham and Women’s Hospital in the United States published the results of an integrated analysis of three clinical trials conducted on atherosclerosis patients and high-risk patients in The Lancet.
Although inflammation and lipid levels have the same effect on the risk of atherosclerotic events, the proportion of inflammation and lipid levels as residual cardiovascular risk may vary as most high-risk patients currently receive treatment based on guidelines including high dose statins.
There is also a report that the risk is reduced when adjuvant lipid-lowering therapy is added, as the concept is that the lower the cholesterol, the better. On the other hand, there is also a report that it is more effective in preventing cardiovascular accidents by adding drugs that focus on anti-inflammation to statins, and the usefulness of colchicine used to prevent gout attacks has been reported.
This clinical trial analysis included three cases: PROMINET, which reviewed pemafibrate as a fibrate-like drug, REDUCE-IT, which reviewed icosapentic acid, and STRENGTH, which compared omega-3 fatty acids and corn oil.
A total of 31,245 subjects were analyzed. All PROMINET participants had type 2 diabetes in 58% of REDUCE-IT and 70% of STRENGTH participants. In addition, the high-intensity statin therapy implementation rates were 72%, 31%, and 50%, respectively.
The range of CRP and high-density LDL-C levels at the start of the trial and the relationship between each level and future cardiovascular accident rates were almost the same in all three trials.
As a result of dividing each level into 4 quartiles, the risk of inflammation was significantly associated with major cardiovascular events, cardiovascular mortality, and total mortality. Cholesterol risk was also significant, but the degree of increase in risk was not significant.
Based on the results of this study, the research team stated, “As a result of analyzing more than 30,000 people receiving treatment based on guidelines including statin therapy, the risk of inflammation, rather than the risk of cholesterol, is a stronger predictor of cardiovascular accidents and deaths.” Further research is needed on inflammation to prevent cardiovascular accidents from occurring.”
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