title: High sensitivity C reactive protein as a prognostic marker in patients with mild to moderate aortic valve stenosis during lipid-lowering treatment: an SEAS substudy.
abstract: To assess the prognostic importance of high-sensitive C reactive protein (hsCRP) in patients with mild to moderate aortic valve stenosis during placebo or simvastatin/ezetimibe treatment in Simvastatin and Ezetimibe in Aortic Stenosis (SEAS).
  
  
  
  In 1620 SEAS patients, we measured lipids and hsCRP at baseline and after 1 year of treatment and registered during 4 years of follow-up major cardiovascular events (MCE) composed of ischaemic cardiovascular events (ICE) and aortic valve-related events (AVE). Simvastatin/ezetimibe reduced low-density lipoprotein cholesterol (3.49 (2.94 to 4.15) to 1.32 (1.02 to 1.69) vs 3.46 (2.92 to 4.08) to 3.34 (2.81 to 3.92) mmol/L) and hsCRP (2.1 (0.9 to 4.1) to 1.2 (0.6 to 2.4) vs 2.2 (0.9 to 4.9) to 1.8 (0.85 to 4.35) mg/L, all p<0.05) during the first year of treatment. In multivariable Cox regression analysis adjusting for traditional risk factors and baseline hsCRP, ICE was associated with a 1-year increase of hsCRP (HR=1.19 (95% CI 1.12 to 1.25), p<0.001) but not with active treatment (HRTreatment=0.86 (0.67 to 1.13), p=0.28). Patients in the top quartile of baseline hsCRP versus the rest were associated with a higher risk of MCE (HR=1.34(1.09 to 1.64), p=0.02). The prognostic benefit of reduction in hsCRP after 1 year was significantly larger (p<0.01 for interaction) in patients with high versus low baseline hsCRP; hence, a reduction in hsCRP abolished the difference in incidence of MCE between high versus low baseline hsCRP in patients with reduced hsCRP (31.1 vs 31.9%, NS) in contrast to patients with increased hsCRP.
  
  
  
  The treatment-associated reduction in ICE was in part related to a reduction in hsCRP but not in lipids. hsCRP reduction was associated with less MCE, especially in patients with high baseline hsCRP.
  
  
  
  NCT00092677.
authors: Department of Cardiology , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark.
authors: Adam
authors: 0000-0002-8452-0972
authors: A
authors: Blyme
authors: Department of Cardiology , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark.
authors: Camilla
authors: C
authors: Asferg
authors: Department of Cardiology , Bispebjerg Hospital , Copenhagen , Denmark.
authors: Olav W
authors: OW
authors: Nielsen
authors: Department of Cardiology , Herlev Hospital , Herlev , Denmark.
authors: Thomas
authors: T
authors: Sehestedt
authors: Department of Medicine , Institute of Clinical Medicine, University of Oulu and Clinical Research Center, Oulu University Hospital , Oulu , Finland.
authors: Y Antero
authors: YA
authors: Kesäniemi
authors: Heart Center Bad Krozingen , Bad Krozingen , Germany.
authors: Christa
authors: C
authors: Gohlke-Bärwolf
authors: Research Unit , Skelelfteå, Institution of Public health and Clinical Medicine, Umeå University , Umeå , Sweden.
authors: Kurt
authors: K
authors: Boman
authors: Heart Health Group and Lund University , Malmö , Sweden.
authors: Ronnie
authors: R
authors: Willenheimer
authors: Department of Cardiology , University Hospitals of South Manchester, Manchester Academic Health Sciences Centre , Manchester , UK.
authors: Simon
authors: S
authors: Ray
authors: Universitätsmedizin Rostock, Zentrum für Innere Medizin, Rostock Univärsitet , Rostock , Germany.
authors: Christoph A
authors: CA
authors: Nienaber
authors: Cardiology Department , Oslo University Hospital , Ullevål , Oslo.
authors: Anne
authors: A
authors: Rossebø
authors: Department of Cardiology , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark.
authors: Kristian
authors: K
authors: Wachtell
authors: The Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology , Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital , Odense , Denmark ; Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Sciences, North-West University , Potchefstroom , South Africa.
authors: Michael H
authors: MH
authors: Olsen