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From the Departments of Medicine, Brigham and Women's Hospital and
Harvard Medical School, Boston, Mass (P.M.R., M.A.P., F.M.S., E.B.); the
Children's Hospital Medical Center, Boston (N.R.); the University of
Texas School of Public Health, Houston (L.A.M.); the Veterans Administration
Medical Center, Tucson, Ariz (S.G.); and the University of Missouri, Columbia
(G.C.F.).
Correspondence to Dr Paul M. Ridker, Division of Cardiovascular Diseases, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail pmridker{at}bics.bwh.harvard.edu
Background—We studied whether
inflammation after myocardial infarction (MI) is a risk factor for
recurrent coronary events and whether randomized treatment with
pravastatin reduces that risk.
Methods and Results—A nested case-control design was used
to compare C-reactive protein (CRP) and serum amyloid A (SAA) levels in
prerandomization blood samples from 391 participants in the
Cholesterol and Recurrent Events (CARE) trial who
subsequently developed recurrent nonfatal MI or a fatal
coronary event (cases) and from an equal number of age- and
sex-matched participants who remained free of these events during
follow-up (control subjects). Overall, CRP and SAA were higher among
cases than control subjects (for CRP P=0.05; for SAA
P=0.006) such that those with levels in the highest
quintile had a relative risk (RR) of recurrent events 75% higher than
those with levels in the lowest quintile (for CRP RR=1.77,
P=0.02; for SAA RR=1.74, P=0.02). The
study group with the highest risk was that with consistent
evidence of inflammation (elevation of both CRP and SAA) who were
randomly assigned to placebo (RR=2.81, P=0.007); this
risk estimate was greater than the product of the individual risks
associated with inflammation or placebo assignment alone. In stratified
analyses, the association between inflammation and risk was
significant among those randomized to placebo (RR=2.11,
P=0.048) but was attenuated and nonsignificant among
those randomized to pravastatin (RR=1.29,
P=0.5).
Conclusions—Evidence of inflammation after MI is associated with
increased risk of recurrent coronary events. Therapy with
pravastatin may decrease this risk, an observation
consistent with a nonlipid effect of this agent.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Inflammation, Pravastatin, and the Risk of Coronary Events After Myocardial Infarction in Patients With Average Cholesterol Levels
Key Words: C-reactive protein • serum amyloid A • myocardial infarction • atherosclerosis • cholesterol
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