(DALLAS) Nov. 9, 2008 – Study results were released today showing that the cholesterol-lowering drug rosuvastatin reduced heart attacks and strokes in patients without high cholesterol but with elevated high-sensitivity C-reactive protein (hsCRP) levels.

Controlling cholesterol is critical for preventing coronary heart disease and reducing heart attack risk. American Heart Association guidelines for reducing the risk of coronary disease events have long recommended a healthy lifestyle and, if needed, medications for lowering cholesterol. These recommendations are based on the joint guidelines of the NHLBI’s Cholesterol Education Program, in which the association participates. The benefit of lowering cholesterol is most evident in secondary prevention, but is also evident in patients without previous events, but at increased risk for coronary disease.

In JUPITER, investigators identified a further group of patients with elevated hs-CRP levels (a marker of inflammation) but with lower risk than is currently recommended for cholesterol-lowering treatment (those with an LDL < 130mg/dl), and demonstrated a benefit for lowering LDL further with a statin. The group was mixed in terms of other risk factors, such as hypertension, metabolic syndrome, smoking, abnormal glucose tolerance, and a positive family history of premature heart disease.

“This study demonstrated a significant reduction in heart attacks and strokes in treating this group, selected from an initially screened group of more than 89,000. However, it was not designed to answer the question of whether the impact on risk was due to a reduction in inflammation (marked by hs-CRP) or a reduction in LDL,” said Timothy Gardner, M.D., president of the American Heart Association.

“Statins lower both LDL cholesterol and hsCRP. Thus, the findings presented today cannot determine whether lowering cholesterol, reducing inflammation, or a combination of both is responsible for the effects seen in this paper.”

In a study by Wilson, et. al., published today in Circulation: Journal of the American Heart Association, researchers concluded that circulating levels of CRP do help to estimate risk for initial cardiovascular events and may be used most effectively in persons at intermediate risk for vascular events, offering moderate improvement in reclassification of risk. These results agree with the 2003 AHA/CDC scientific statement about the use of markers of inflammation such as hs-CRP. In the Wilson study, using the Framingham data, CRP did also offer some ability to reclassify individuals at lower risk.

In the 2003 statement the American Heart Association and the Centers for Disease Control and Prevention concluded that measurement of CRP is not useful for broad screening of the entire American adult population. Rather, at a physician’s discretion, it was suggested to be useful for people at intermediate risk, to determine the specific preventive measures that might be employed. For those at high risk, treatment should already be aggressive. The new studies raise the question of how much CRP measurement will help define treatment for people at low risk, and these studies will be included in the ongoing updating of guidelines for prevention.