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Title
Inflammation, pravastatin, and the risk of coronary
events after myocardial infarction in patients with
average cholesterol levels.
Purpose
To determine whether inflammation plays a role in recurrent
events following myocardial infarction .
Design
Control substudy of CARE trial .
Patients
391 patients in CARE trial who developed recurrent
non-fatal MI or fatal coronary event (cases), and comparison
to equal number of controls that were age and sex matched
but remained free of recurrent cardiac event (controls).
Follow-up
As per CARE
Treatment regimen
As per CARE
Results
• C-reactive protein (CRP) and serum amyloid A
(SAA), markers of inflammation, were highest among cases
vs
controls.
• Patients with highest quintiles had a relative
risk of recurrent events that was 75% higher than patients
in the lowest
quintile (p=0.02).
• Highest risk of recurrent events occurred in
the placebo patients with elevations of both CRP and
SAA.
• Assessment of stratified analysis revealed that
while the association between inflammation and the risk
of recurrent
events was increased in patients randomized to placebo
(RR=2.11, p=0.048), this association was not significant
in
patients randomized to pravastatin (RR=1.29, p=0.5)
.
Conclusion
Inflammation assessed by elevations of C-reactive protein
and serum amyloid following myocardial infarction is
associated
with recurrent cardiac events; pravastatin may reduce
the risk.
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