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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effects of statin therapy according to plasma high-sensitivity C-reactive protein concentration in the controlled rosuvastatin multinational trial in heart failure (CORONA): A retrospective analysis
Circulation, Volume 120, No. 22, Year 2009
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Description
BACKGROUND- We examined whether the antiinflammatory action of statins may be of benefit in heart failure, a state characterized by inflammation in which low cholesterol is associated with worse outcomes. METHODS AND RESULTS: We compared 10 mg rosuvastatin daily with placebo in patients with ischemic systolic heart failure according to baseline high sensitivity-C reactive protein (hs-CRP) <2.0 mg/L (placebo, n=779; rosuvastatin, n=777) or >2.0 mg/L (placebo, n=1694; rosuvastatin, n=1711). The primary outcome was cardiovascular death, myocardial infarction, or stroke. Baseline low-density lipoprotein was the same, and rosuvastatin reduced low-density lipoprotein by 47% in both hs-CRP groups. Median hs-CRP was 1.10 mg/L in the lower and 5.60 mg/L in the higher hs-CRP group, with higher hs-CRP associated with worse outcomes. The change in hs-CRP with rosuvastatin from baseline to 3 months was-6% in the low hs-CRP group (27% with placebo) and-33.3% in the high hs-CRP group (-11.1% with placebo). In the high hs-CRP group, 548 placebo-treated (14.0 per 100 patient-years of follow-up) and 498 rosuvastatin-treated (12.2 per 100 patient-years of follow-up) patients had a primary end point (hazard ratio of placebo to rosuvastatin, 0.87; 95% confidence interval, 0.77 to 0.98; P=0.024). In the low hs-CRP group, 175 placebo-treated (8.9 per 100 patient-years of follow-up) and 188 rosuvastatin-treated (9.8 per 100 patient-years of follow-up) patients experienced this outcome (hazard ratio, 1.09; 95% confidence interval, 0.89 to 1.34; P>0.2; P for interaction=0.062). The numbers of deaths were as follows: 581 placebo-treated (14.1 per 100 patient-years of follow-up) and 532 rosuvastatin-treated (12.6 per 100 patient-years) patients in the high hs-CRP group (hazard ratio, 0.89; 95% confidence interval, 0.79 to 1.00; P=0.050) and 170 placebo-treated (8.3 per 100 patient-years) and 192 rosuvastatin-treated (9.7 per 100 patient-years) patients in the low hs-CRP group (hazard ratio, 1.17; 95% confidence interval, 0.95 to 1.43; P=0.14; P for interaction=0.026). CONCLUSION: In this retrospective hypothesis-generating study, we found a significant interaction between hs-CRP and the effect of rosuvastatin for most end points whereby rosuvastatin treatment was associated with better outcomes in patients with hs-CRP >2.0 mg/L. © 2009 American Heart Association, Inc.
Authors & Co-Authors
McMurray, John JV
United Kingdom, Glasgow
Glasgow Cardiovascular Research Centre
Kjekshus, John K.
Norway, Oslo
Rikshospitalet-radiumhospitalet hf
Gullestad, Lars Lysgaard
Norway, Oslo
Rikshospitalet-radiumhospitalet hf
Dunselman, Peter H.J.M.
Netherlands, Breda
Amphia Hospital
Hjalmarson, Årke C.
Sweden, Gothenburg
Sahlgrenska Akademin
Wedel, Hans
Sweden, Gothenburg
Nordiska Högskolan För Folkhälsovetenskap
Lindberg, Magnus B.
Sweden, Sodertalje
Astrazeneca Sweden
Waagstein, Finn
Sweden, Gothenburg
Sahlgrenska Akademin
Grande, Peer I.
Denmark, Copenhagen
Københavns Universitet
Hradec, Jaromír
Czech Republic, Prague
Všeobecná Fakultní Nemocnice V Praze
Kamenský, Gabriel
Slovakia, Bratislava
University Hospital in Bratislava
Korewicki, Jerzy
Poland, Warsaw
Instytut Kardiologii Im. Prymasa Tysiaclecia Stefana Kardynała Wyszynskiego
Kuusi, Timo
Finland, Helsinki
Helsinki University Hospital
MacH, François
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Ranjith, Naresh
South Africa, Durban
The Nelson R. Mandela Medical School
Wikstrand, John C.M.
Sweden, Gothenburg
Sahlgrenska Akademin
Statistics
Citations: 162
Authors: 16
Affiliations: 13
Identifiers
Doi:
10.1161/CIRCULATIONAHA.109.849117
ISSN:
00097322
e-ISSN:
15244539
Research Areas
Environmental
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study