title: Inflammatory predictors of mortality in the Scandinavian Simvastatin Survival Study.
abstract: OBJECTIVE
  The predictive value of specific markers of infection and autoimmunity for coronary events, such as the effects of statins on inflammation, is still controversial.
  
  
  METHODS
  A case-control design was used to compare C-reactive protein (CRP) levels, seropositivity for Chlamydia pneumoniae and Helicobacter pylori, and anti-oxidized low-density lipoprotein (oxLDL) antibody levels in prerandomization blood samples from 129 participants in the Scandinavian Simvastatin Survival Study who died (cases), and from 129 matched participants who were alive during 5-year follow-up (controls).
  
  
  RESULTS
  Patients with CRP levels in the highest quartile had an increased risk of death compared with those in the first through third quartile (odds ratio [OR] = 2.51, 95% confidence interval [CI] 1.3-4.8). Seropositivity for Chlamydia pneumoniae or Helicobacter pylori and anti-oxLDL antibody levels were similar in cases and controls (p = NS). At a 4-month control, simvastatin reduced CRP levels (p = 0.009) while placebo did not (p = NS). However, the risk of death associated with high baseline CRP levels was similar in patients randomized to placebo (OR = 2.36, 95% CI 1.06-5.26) or simvastatin (OR = 3.13, 95% CI 1.06-9.21).
  
  
  CONCLUSIONS
  Elevated CRP levels, but not seropositivity for Chlamydia pneumoniae or Helicobacter pylori, nor levels of anti-oxLDL antibodies, predict the risk of death in patients with stable ischemic heart disease. Simvastatin treatment reduces CRP levels, but without affecting the increased risk conferred by higher CRP levels at baseline.
authors.affiliation: Istituto di Cardiologia, Università Cattolica, Rome, Italy. f.crea@flashnet.it
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Claudia
authors.initials: C
authors.lastname: Monaco
authors.forename: Gaetano A
authors.initials: GA
authors.lastname: Lanza
authors.forename: Elena
authors.initials: E
authors.lastname: Maggi
authors.forename: Francesca
authors.initials: F
authors.lastname: Ginnetti
authors.forename: Domenico
authors.initials: D
authors.lastname: Cianflone
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Thomas
authors.initials: T
authors.lastname: Cook
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bellomo
authors.forename: John
authors.initials: J
authors.lastname: Kjekshus
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D019821:Simvastatin / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D014280:Triglycerides; D002097:C-Reactive Protein; D019821:Simvastatin