BARCELONA — C-reactive protein was among 17 novel biomarkers of inflammation and atherosclerosis that failed to predict future cardiovascular events in statin-treated patients with established coronary heart disease, in a post hoc subanalysis of the landmark Treating to New Targets (TNT) study.
Indeed, only 1 of the 18 biomarkers assessed in the study proved predictive of major cardiovascular events: osteopontin. At baseline, when TNT participants had already been on atorvastatin (Lipitor) at 10 mg/day for 8 weeks, a low osteopontin level was associated with a significant 16% increase in the risk of cardiovascular events during the median 4.9 years of follow-up, Dr. John J.P. Kastelein reported at the annual congress of the European Society of Cardiology.
In marked contrast to the underperformance of the novel biomarkers, on-treatment levels of the traditional lipid risk factors—LDL cholesterol, HDL cholesterol, and triglycerides—were powerful predictors of major cardiovascular events. The implication is that the appropriate treatment strategy in patients with established CHD is to put them on a statin, titrate to a dose that achieves guideline-recommended lipid levels, and don't bother messing around with the novel biomarkers, which do not offer increased predictive power over the standard lipids.
“Until further evidence is available and/or guidelines recommend otherwise, clinical decisions around statin therapy might continue to focus on traditional contributors to cardiovascular risk,” said Dr. Kastelein, professor of medicine and chairman of the department of vascular medicine at the Academic Medical Center of the University of Amsterdam.
The post hoc nested case-control study utilized stored plasma samples from 507 TNT participants who experienced a major cardiovascular event—CHD death, nonfatal MI, fatal or nonfatal stroke, or resuscitated cardiac arrest—and 1,020 controls who did not. The biomarkers were measured in samples obtained after 8 weeks on low-dose atorvastatin during the study run-in period and again in samples gathered after 1 year of randomized treatment.
An on-treatment elevated LDL cholesterol level was associated with a 2.1-fold increased risk of major cardiovascular events. The main TNT trial as well as this analysis were sponsored by Pfizer.
In statin patients, novel biomarkers do not offer increased predictive power over the standard lipids.
Source DR. KASTELEIN