From the Guidelines
Statins significantly reduce C-Reactive Protein (CRP) levels.
Effect of Statins on CRP Levels
- The Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial demonstrated a decrease in CRP by 37% with rosuvastatin, which lowered CVD event rates by 50% independently of a reduction in low-density lipoprotein levels 1.
- The reduction in CRP levels with statin therapy is thought to be partly due to the pleiotropic effects of statins, although the exact mechanism is still debated 1.
- A study found that only 2% to 11% of the CRP change could not be accounted for by LDL lowering, suggesting that the majority of the reduction in CRP is due to the lipid-lowering effects of statins 1.
- However, the clinical significance of reducing CRP levels with statins is still uncertain, and there is insufficient evidence that a reduction in CRP levels results in fewer CVD events 1.
Clinical Implications
- The use of CRP as a risk predictor of coronary heart disease is still not widely recommended, and CRP is not currently included in any of the major risk prediction calculators 1.
- The effects of using CRP in addition to traditional CVD risk factors to guide the prescription of statins for reducing CVD risk are uncertain, and the USPSTF does not recommend for or against the use of CRP alone as a risk factor in screening to prevent CVD events 1.
From the Research
Effect of Statins on C-Reactive Protein (CRP) Levels
- Statins have been shown to reduce CRP levels in patients with cardiovascular diseases (CVDs) 2, 3, 4, 5, 6
- A systematic review and meta-analysis of randomized controlled trials found that statins reduced serum levels of hs-CRP (WMD = -0.97 mg/L; 95% CI: -1.26 to -0.68 mg/L; P < 0.001) and CRP (WMD = -3.05 mg/L; 95% CI: -4.86 to -1.25 mg/L; P < 0.001) in patients with CVDs 2
- The reduction in CRP levels was independent of LDL-C lowering, and variation between statins in CRP reduction may play a role in CVD event reduction rates 5
- A prospective trial found that pravastatin reduced median CRP levels by 16.9% (P<0.001) at 24 weeks, reflecting a decrease of 0.02 mg/dL in the pravastatin group while no change in CRP levels was observed in the placebo group 6
Mechanisms and Clinical Relevance
- The mechanisms of reduction of CRP levels by statins involve anti-inflammatory effects, which may play a role in the reduction of cardiovascular events 3, 6
- The clinical relevance of lowering CRP with statins is still being studied, but it may be more interesting in secondary prevention due to a more pronounced state of inflammation 3
- Statins may have anti-inflammatory effects in addition to lipid-lowering effects, which could contribute to their cardiovascular benefits 6
Patient Subgroups and Treatment Duration
- The effect of statins on CRP levels was present among all prespecified subgroups according to sex, age, smoking status, body mass index, baseline lipid levels, presence of diabetes, and use of aspirin or hormone replacement therapy 6
- The duration of treatment longer than 10 weeks decreased hs-CRP levels in patients with CVDs 2
- High-intensity statin treatment could marginally decrease serum levels of CRP in CVDs patients 2