title: On-treatment C-reactive protein and HDL cholesterol levels in patients at intermediate cardiovascular risk: impact on carotid intima-media thickness.
abstract: OBJECTIVE
  Statin therapy is followed by reductions in carotid intima-media thickness (CIMT) and C-reactive protein (CRP) levels, but a significant number of treated patients still have increased CIMT. We investigated whether on-treatment levels of CRP are associated with CIMT in hypercholesterolemic patients receiving statin therapy. The influence of blood pressure and anti-hypertensive therapy on the association between CRP and CIMT was evaluated.
  
  
  METHODS
  The assessment of cardiovascular risk factors, CRP and CIMT, was performed in a cross-sectional study of 240 hypercholesterolemic patients at intermediate cardiovascular risk under statin therapy; 125 patients received only a statin (statin group) and 115 also anti-hypertensive therapy (combined therapy group).
  
  
  RESULTS
  Logarithmically transformed CRP (β=0.17, p=0.01) and HDL cholesterol levels (β=-0.27, p<0.001) were correlates of CIMT, irrespective of confounders. High CRP levels (>3mg/L) were associated with a 2.7-fold increased risk of having high CIMT (>1.25mm). High CIMT was present in a high percentage of patients not at target for cholesterol and blood pressure levels (61%). Patients in the statin group had lower Framingham risk and CIMT than those in the combined therapy group. In the statin group, logarithmically transformed CRP (β=0.28, p=0.004) and HDL cholesterol (β=-0.21, p=0.03) were associated with CIMT. In the combined therapy group, HDL cholesterol was the only significant CIMT correlate (β=-0.33, p=0.001).
  
  
  CONCLUSIONS
  On-treatment CRP and HDL cholesterol levels are associated with CIMT among hypercholesterolemic patients under statin therapy. In patients receiving both statin and anti-hypertensive therapy, HDL cholesterol remains the main covariate of CIMT.
authors.affiliation: Angiology and Arteriosclerosis Diseases, Department of Clinical and Experimental Medicine, University of Perugia, Italy. mpirro@unipg.it
authors.forename: Matteo
authors.initials: M
authors.lastname: Pirro
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vaudo
authors.forename: Graziana
authors.initials: G
authors.lastname: Lupattelli
authors.forename: Leonella
authors.initials: L
authors.lastname: Pasqualini
authors.forename: Massimo R
authors.initials: MR
authors.lastname: Mannarino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
authors.forename: Abdalkader
authors.initials: A
authors.lastname: Alaeddin
authors.forename: Francesco
authors.initials: F
authors.lastname: Paciullo
authors.forename: Francesca
authors.initials: F
authors.lastname: Fallarino
authors.forename: Francesco
authors.initials: F
authors.lastname: Bagaglia
authors.forename: Elmo
authors.initials: E
authors.lastname: Mannarino
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D059168:Carotid Intima-Media Thickness; D008076:Cholesterol, HDL / Q000097:blood*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein
keywords: Atherosclerosis; C-reactive protein; Carotid; Hypercholesterolemia; Intima-media thickness; Statin