Abstract TMP94: Treatment With Pravastatin Decreases the Level of Serum Hs-CRP in Ischemic Stroke Patients - Hs-CRP Sub-study of the Japan Statin Treatment Against Recurrent Stroke (J-STARS)
Background and Purpose: Serum hs-CRP level has been shown as a reliable marker of vascular inflammation. One of the pleiotropic effect of statin could be anti-inflammation shown as decrease of hs-CRP level. However, it remains unclear whether statin decreases the hs-CRP level in ischemic stroke patients. This is a sub-study of J-STARS, and the primary outcome was change of hs-CRP after statin treatment. The secondary outcome was whether mean hs-CRP level during follow-up period is associated with recurrent stroke and transient ischemic attack (TIA), and all vascular event.
Methods: Among 1578 patients enrolled in J-STARS, 1095 were included in Hs-CRP sub-study. Those were randomly assigned to pravastatin (n=545) or control group (n=550). The pravastatin group patients received 10 mg of pravastatin/day. Blood samples were obtained at baseline and 2, 6 months, 2 and 5 years after randomization. Hs-CRP levels were log-transformed for statistical analysis.
Results: Baseline average hs-CRP level was 691 ng/L. Hs-CRP level was significantly decreased 2 months after pravastatin treatment, and remained significantly lower until the end of study. However, hs-CRP level did not show significant change in the control group. One SD increase of mean hs-CRP level during follow-up tended to increase the risk of stroke/TIA recurrence (HR 1.18, 95%CI 0.99-1.40, p=0.065) and significantly increased the risk of all vascular events (HR1.28, 95%CI 1.10-1.49, p<0.01). After adjustment with risk factors, the association between 1SD increase of hs-CRP and all vascular events remained significant. When cut-off level of hs-CRP level during follow-up was determined as 1000 ng/L, higher CRP level significantly increased the risk of stroke/TIA (HR 1.47, 95%CI 1.04-2.09, p=0.03) and all vascular events (HR 1.63, 95%CI 1.20-2.21, p<0.01). After adjustment, the association with stroke/TIA was of borderline significance (p=0.06) but remained significant with all vascular events (p=0.01).
Conclusion: Low dose pravastatin significantly decreased the level of hs-CRP in ischemic stroke patients. High hs-CRP level during follow-up, particularly beyond 1000 ng/l, tended to increase the stroke/TIA recurrence and was significantly associated with the risk of all vascular events.
Author Disclosures: K. Kitagawa: Other Research Support; Modest; Boehringer Ingelheim, Ohstuka, Daiichi Sankyo. Speakers' Bureau; Modest; Bristyol Myers Aquibb, Ohstuka, Pfizer, Boehringer Ingelheim, AstraZeneca. Speakers' Bureau; Significant; Daiichi-SankyoOtsuka, Sanofi, Bayer. N. Hosomi: None. Y. Nagai: None. T. Kagimura: None. H. Origasa: None. K. Minematsu: Research Grant; Modest; Lundbeck. Honoraria; Modest; Mitsubishi Tanabe Pharma, Kyowa Hakko Kirin, Sanofi, Ohtsuka, Bayer, Asteras Pharma, Daiichi Sankyo, AstraZeneca, EPS, Boehringer-Ingelheim, Pfizer, Stryker, Medicos Hirata. S. Uchiyama: Research Grant; Modest; Ohtsuka, Sanofi, Boehringer Ingelheim, Daiichi Sankyo, Bayer. Honoraria; Modest; Sanofi, Boehringer Ingelheim, Daiichi Sankyo. Honoraria; Significant; Ohtsuka, Bayer. M. Nakamura: None. M. Matsumoto: None.
- © 2016 by American Heart Association, Inc.