Elevated serum inflammatory marker levels are associated with a greater long-term risk of cardiovascular events. Because 3-hydroxy-3-methylglutaryl
coenzyme-A reductase inhibitors (
statins) may have an antiinflammatory action, it has been suggested that patients with elevated inflammatory marker levels may have a greater reduction in cardiovascular risk with
statin treatment.
METHODS AND RESULTS: We evaluated the association between the white blood cell count (WBC) and
coronary heart disease mortality during a mean follow-up of 6.0 years in the Long-Term Intervention With
Pravastatin in Ischemic Disease (
LIPID) Study, a clinical trial comparing
pravastatin (40 mg/d) with a placebo in 9014 stable patients with previous
myocardial infarction or
unstable angina. An increase in baseline WBC was associated with greater
coronary heart disease mortality in patients randomized to placebo (hazard ratio for 1x10(9)/L increase in WBC, 1.18; 95% CI, 1.12 to 1.25; P<0.001) but not
pravastatin (hazard ratio, 1.02; 95% CI, 0.96 to 1.09; P=0.56; P for interaction=0.004). The numbers of
coronary heart disease deaths prevented per 1000 patients treated with
pravastatin were 0, 9, 30, and 38 for baseline WBC quartiles of <5.9, 6.0 to 6.9, 7.0 to 8.1, and >8.2x10(9)/L, respectively. WBC was a stronger predictor of this treatment benefit than the ratio of total to
high-density lipoprotein cholesterol and a global measure of cardiac risk. There was also a greater reduction (P=0.052) in the combined incidence of cardiovascular mortality, nonfatal
myocardial infarction, and
stroke with
pravastatin as baseline WBC increased (by quartile: 3, 41, 61, and 60 events prevented per 1000 patients treated, respectively).
CONCLUSIONS: