Open AccessInflammatory predictors of mortality in the scandinavian simvastatin survival study
Author(s) -
Crea Filippo,
Monaco Cmlaudia,
Lanza Gaetano A.,
Maggi Elena,
Ginnetti Francesca,
Cianflone Domenico,
Niccoli Giampaolo,
Cook Thomas,
Bellomo Giorgio,
Kjekshus John
Publication year - 2002
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960251005
Subject(s) - medicine , simvastatin , chlamydia , c reactive protein , quartile , odds ratio , gastroenterology , helicobacter pylori , confidence interval , placebo , immunology , atorvastatin , inflammation , pathology , alternative medicine
Background and hypothesis : 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.