http://www.theheart.org/web_slides/1185967.do A post hoc analysis of the trial's lipid-lowering arm designed to evaluate the importance of high-sensitivity C-reactive protein (hs-CRP) in measuring CV risk

1. ASCOT-CRP (Anglo-Scandinavian Cardiac
Outcomes Trial—C-Reactive Protein)

2. ASCOT-CRP (Anglo-Scandinavian Cardiac
Outcomes Trial—C-Reactive Protein)
PS Sever (Imperial College, London, UK)
American Heart Association 2010 Scientific Sessions
• A post hoc analysis of the trial's lipid-lowering arm designed to evaluate the
importance of high-sensitivity C-reactive protein (hs-CRP) in measuring CV risk
• Included 485 patients:
Who reached the composite end point (CV death, nonfatal MI, coronary
revascularization, or fatal/nonfatal stroke)
Were age- and sex-matched to 1367 patients in the control group who hadn't
suffered one of those events
Were followed for 5.5 years

3. ASCOT-CRP: Results
Measuring hs-CRP had little to no utility in refining CV risk assessment beyond
classic risk factors
• Baseline levels of hs-CRP and LDL-C were significantly correlated with each other
(p<0.0001) and both were predictive of the composite CV end point:
OR 1.31 (95% CI 1.10–1.56; p=0.002) for LDL-C
OR 1.19 (95% CI 1.05–1.34; p=0.006) for every one–standard-deviation increase
in hs-CRP
• Lower on-treatment LDL-C but not hs-CRP was associated with a highly significant
reduction in CV events over six months:
LDL-C <2.1 mmol/L (median) vs LDL-C ≥ 2.1 mmol/L predicted a reduction in the
composite end point (adjusted OR=0.41, 95% CI 0.22–0.75; p=0.004)
hs-CRP <1.83 mg/L (median) vs hs-CRP ≥ 1.83 mg/L showed no such predictive
effect (adjusted OR=0.86, 95% CI 0.49–1.51; p=0.60)

4. ASCOT-CRP: Commentary*
"It is clear that achievement of low LDL-cholesterol levels confers great benefit, and
there's no added benefit by achieving a lower CRP level."
- Dr Peter S Sever
"I'm not as convinced as Dr Sever that this damages the CRP hypothesis."
- Dr Roger Blumenthal
"It's a post hoc analysis of a previously published trial and we must take it with a
grain of salt. It was a particularly high-risk primary-prevention cohort, and it's fair to
say there were a relatively small number of events."
- Dr Donald Lloyd Jones
*All comments from ASCOT analysis fuels debate over JUPITER-based CRP indication for statins
(http://www.theheart.org/article/1153661.do)

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