Physicians' Academy for Cardiovascular Education

Low hs-CRP associated with lower risk of adverse outcomes in primary prevention cohort

Associations between very low concentrations of low density lipoprotein cholesterol, high sensitivity C-reactive protein, and health outcomes in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study

Literature - Penson PE, Leann Long D, Howard G, et al. - Eur Heart J 2018; published online ahead of print

Introduction and methods

Reduction in plasma LDL-c has repeatedly been associated with improved cardiovascular (CV) morbidity and mortality in primary and secondary prevention. However, CV risk is often not entirely eliminated, even when LDL-c target values are met [1]. It is hypothesized that the residual CV risk may be due to inflammation [2].

In this analysis of the REasons for Geographical And Racial Differences in Stroke (REGARDS) study [3], the relationship between high sensitivity C-reactive protein (hs-CRP), LDL-c and clinical outcomes was investigated, in patients with similar LDL-c levels and a high baseline 10 year risk (Framingham-CHD ≥10% or ASCVD ≥7.5%). REGARDS is a longitudinal cohort study that recruited 30,239 non-hispanic black or white participants, aged ≥45 years between 2003 and 2007. Outcome measures included all-cause mortality, incident coronary heart disease (CHD), and incident stroke.

Main results


In a primary prevention cohort, the combination of LDL-c ≥70 mg and low hs-CRP (<2 mg/L) was associated with a reduced risk of stroke, CHD, and CHD-death, compared with patients in the same LDL-c category and high hs-CRP levels. LDL-c levels below 70 mg/dL were not associated with protective effects, in several analyses. These data support the important role of inflammatory processes in the pathogenesis of CVD.


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Find this article online at Eur Heart J

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