Therapeutic options to further lower C-reactive protein for patients on statin treatment

Cardiovascular disease remains the leading cause of morbidity and mortality in developed nations. Inflammation plays an increasingly important role in the cardiovascular disease process. Recent statin trials have demonstrated a correlation between the inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) and cardiovascular risk. This review describes the results of changes in hsCRP in the major statin outcome trials and the concept of a "dual target" for both low-density lipoprotein cholesterol and hsCRP. The effect on hsCRP of combination statin therapy with ezetimibe, fenofibric acid, niacin, and colesevelam is reviewed. Although some statin combination therapies have additional effects on CRP and other atherogenic lipids, evidence for their effect on cardiovascular risk beyond statin monotherapy is lacking. Ongoing placebo-controlled trials investigating statin combination therapy versus statin monotherapy may provide additional clues to the role of additional changes in lipids versus markers of inflammation on cardiovascular risk reduction. Until these trials are completed, current evidence suggests focusing on lowdensity lipoprotein cholesterol targets.