title: C-reactive protein level and the incidence of eligibility for statin therapy: the multi-ethnic study of atherosclerosis.
abstract: BACKGROUND
  Given the results of the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial, statin initiation may be considered for individuals with elevated high-sensitivity C-reactive protein (hsCRP). However, if followed prospectively, many individuals with elevated CRP may become statin eligible, limiting the impact of elevated CRP as a treatment indication. This analysis estimates the proportion of people with elevated CRP that become statin eligible over time.
  
  
  OBJECTIVE
  Most people with elevated CRP become statin eligible over a short period of time.
  
  
  METHODS
  We followed 2153 Multi-Ethnic Study of Atherosclerosis (MESA) participants free of cardiovascular disease and diabetes with low-density lipoprotein cholesterol <130 mg/dL at baseline to determine the proportion who become eligible for statins over 4.5 years. The proportion eligible for statin therapy, defined by the National Cholesterol Education Program (NCEP) 2004 updated guidelines, was calculated at baseline and during follow-up stratified by baseline CRP level (≥2 mg/L).
  
  
  RESULTS
  At baseline, 47% of the 2153 participants had elevated CRP. Among participants with elevated CRP, 29% met NCEP criteria for statins, compared with 28% without elevated CRP at baseline. By 1.5 years later, 26% and 22% (P = 0.09) of those with and without elevated CRP at baseline reached NCEP low-density lipoprotein cholesterol criteria and/or had started statins, respectively. These increased to 42% and 39% (P = 0.24) at 3 years and 59% and 52% (P = 0.01) at 4.5 years following baseline.
  
  
  CONCLUSIONS
  A substantial proportion of those with elevated CRP did not achieve NCEP-based statin eligibility over 4.5 years of follow-up. These findings suggest that many patients with elevated CRP may not receive the benefits of statins if CRP is not incorporated into the NCEP screening strategy.
authors.affiliation: Department of Medicine, Division of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts 02119, USA. dmann@bu.edu
authors.forename: Devin M
authors.initials: DM
authors.lastname: Mann
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: Susan
authors.initials: S
authors.lastname: Lakoski
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000097:blood* / Q000208:ethnology* / Q000517:prevention & control; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D005006:Ethnicity; D005260:Female; D005464:Fluorobenzenes / Q000008:administration & dosage* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011743:Pyrimidines / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D002097:C-Reactive Protein