title: The association of albuminuria and high-sensitivity C-reactive protein with the efficacy of HMG-coenzyme A reductase inhibitors for cardiovascular event prevention.
abstract: It is not clear which hypercholesterolemic patients benefit most from β-hydroxy-β-methylglutaryl coenzyme A reductase inhibitors with respect to the prevention of cardiovascular events. Early signs of atherosclerotic vascular damage may identify high-risk patients.
  
  
  
  We studied whether subjects with hypercholesterolemia will benefit more from starting statin treatment in the case of high albuminuria and/or high-sensitivity C-reactive protein (hsCRP).
  
  
  
  Included were subjects who had hypercholesterolemia at baseline, a negative cardiovascular disease history and who were not treated with statins. In total, 2011 subjects were analysed, of whom 695 started with a statin during a follow-up of 7.0 ± 1.7 years. Adjusted hazard ratios (HRs) for cardiovascular events were calculated in subjects who started versus those who did not start a statin stratified for albuminuria less than or ≥ 15 mg/day and/or hsCRP less than or ≥ 3 mg/L.
  
  
  
  The start of a statin was associated with a beneficial effect on cardiovascular risk in subjects with high albuminuria (HR 0.38 (0.23-0.60)), while the effect of starting a statin was non-significant in subjects with low albuminuria (HR 0.74 (0.44-1.24), P for interaction < 0.05). The effect of starting a statin was similar in subgroups with high and low hsCRP (P for interaction 0.34). When combining albuminuria and hsCRP subgroups, the start of statin treatment was associated with a lower risk of cardiovascular events dependent on albuminuria and not on the hsCRP level.
  
  
  
  The start of statin treatment is associated with a significantly lower absolute as well as relative risk of cardiovascular events in subjects with hypercholesterolemia and elevated albuminuria, whereas these drugs had less effect in subjects with normal albuminuria.
authors.affiliation: Department of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands a.ozyilmaz@umcg.nl.
authors.forename: Akin
authors.initials: A
authors.lastname: Özyilmaz
authors.affiliation: Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, The Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Boersma
authors.affiliation: Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, The Netherlands.
authors.forename: Sipke T
authors.initials: ST
authors.lastname: Visser
authors.affiliation: Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
authors.affiliation: Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, The Netherlands.
authors.forename: Lolkje Tw
authors.initials: LT
authors.lastname: de Jong-van den Berg
authors.affiliation: Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Hiddo J
authors.initials: HJ
authors.lastname: Lambers-Heerspink
authors.affiliation: Department of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.affiliation: Department of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein
keywords: Albuminuria; HMG-CoA reductase inhibitor; cardiovascular event; high-sensitivity C-reactive protein