C-reactive protein and future cardiovascular events in statin-treated patients with angina pectoris: the extended TRUTH study.

Abstract

AIM:

The TRUTH trial demonstrated that 8-month statin therapy alters the composition of coronary artery plaque using virtual histology (VH)-intravascular ultrasound (IVUS). The extended TRUTH study was conducted to evaluate the relationship between changes in coronary atherosclerosis and mid-term clinical outcomes and identify the factors associated with cardiovascular events.

METHODS:

Of 164 patients with angina pectoris who participated in the TRUTH trial, 119 subjects with analyzable IVUS data at both enrollment and the 8-month follow-up were enrolled and observed for at least two years. The primary end point was the time to first occurrence of cardiovascular composite events, including cardiovascular death, nonfatal myocardial infarction, nonfatal cerebral infarction, unstable angina and ischemic-driven revascularization, except for target lesion revascularization.

RESULTS:

The frequency of reaching the primary end point was 13% (16/119), with a mean follow-up period of 41.9±9.4 months. Although plaque regression and changes in plaque composition were not associated with future cardiovascular events, the serum high-sensitivity C-reactive protein (hs-CRP) levels at the start of the extended TRUTH study were significantly higher in the event group than in the event-free group (1.43 mg/L vs. 0.58 mg/L, p=0.01). A multivariate logistic regression analysis showed that the hs-CRP level was an independent significant predictor of cardiovascular events (odds ratio: 1.69; 95% confidence interval: 1.14-2.50, p=0.01).

CONCLUSIONS:

Coronary artery plaque regression and changes in plaque composition during statin therapy do not predict future cardiovascular events in patients with angina pectoris. Instead, the serum hs-CRP level can be used as a predictor of cardiovascular events.

• Authors: Tsuyoshi Nozue, Kazuki Fukui, Shingo Yamamoto, Tomoyuki Kunishima, Shigeo Umezawa, Yuko Onishi, Shinichi Tohyama, Youichi Takeyama, Yoshihiro Morino, Takao Yamauchi, Kiyoshi Hibi, Takashi Sozu, Mitsuyasu Terashima, Ichiro Michishita, TRUTH Investigators
• Journal: Journal of atherosclerosis and thrombosis (J Atheroscler Thromb) Vol. 20 Issue 9 Pg. 717-25 ( 2013) ISSN: 1880-3873 [Electronic] Japan
• PMID: 23748166 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Quinolines
• C-Reactive Protein
• Pravastatin
• pitavastatin

Topics

• Aged
• Angina Pectoris (diagnostic imaging, drug therapy)
• C-Reactive Protein (metabolism)
• Cardiovascular Diseases (blood, diagnosis)
• Coronary Artery Disease (blood, diagnostic imaging, drug therapy)
• Female
• Follow-Up Studies
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Ischemia (pathology)
• Japan
• Male
• Middle Aged
• Myocardial Infarction (blood, diagnosis)
• Plaque, Atherosclerotic (diagnosis)
• Pravastatin (therapeutic use)
• Prospective Studies
• Quinolines (therapeutic use)
• Regression Analysis
• Risk Factors
• Treatment Outcome
• Ultrasonography, Interventional