Effect of atorvastatin on circulating hsCRP concentrations: A sub-study of the Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) study

Abstract

Background: Elevated C-reactive protein (CRP) concentration is a risk factor for cardiovascular events that may add prognostic information. Statin treatment is associated with significant reductions in CRP concentrations, which appear to be unrelated to the magnitude of LDL-cholesterol reduction. We investigated the effect of atorvastatin, across its dose range, on high sensitivity (hs)CRP in subjects at high cardiovascular risk. Methods: ACTFAST was a 12 week, prospective, multicenter, open-label trial in which high-risk subjects were assigned a starting dose of atorvastatin (10,20,40 Results: At baseline, ST subjects had significantly lower hsCRP levels than SF subjects (ST group 2.31, 95% CI 2.15, 2.48 mg/L vs. SF group 3.16, 95% CI 2.98, 3.34 mg/L, p b 0.05). In the SF group, atorvastatin 10 to 80 mg significantly (p b 0.01) reduced hsCRP levels in a dose dependent-manner. In ST group, additional hsCRP reductions were observed over the statin used at baseline, which were not dosedependent. Atorvastatin significantly decreased hsCRP concentrations in subjects with or without diabetes or the metabolic syndrome. Conclusions: Atorvastatin treatment at different doses, particularly 80 mg, significantly reduced hsCRP serum concentrations. This reduction was observed in both SF and ST groups and was independent of the presence of metabolic syndrome and/or diabetes. The beneficial effect of atorvastatin was evident at 6 weeks, supporting the practice of early introduction of higher doses of atorvastatin in high-risk patients.

Alogliptin, a Dipeptidyl Peptidase 4 Inhibitor, Prevents the Progression of Carotid Atherosclerosis in Patients With Type 2 Diabetes: The Study of Preventive Effects of Alogliptin on Diabetic Atherosclerosis (SPEAD-A)

“…Indeed, one previous study showed that 3-week treatment with a-glucosidase inhibitors reduced the levels of inflammatory and cell adhesion markers in patients with T2DM (28). Furthermore, short-term statin treatment is reported to improve inflammation (29). In addition, our results showed a significant reduction of BMI in the conventional treatment group.…”

Targeting Dyslipidemia in the Metabolic Syndrome: An Update

“…These results were recently verified in the Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) 1 and 2 studies [40][41][42]. ACTFAST was a 12 week, prospective, multicenter, open-label trial in which high-risk subjects were assigned to a starting dose of atorvastatin (10, 20, 40 or 80 mg/d) based on LDL-C and status of statin use at screening (772 previous statin use vs 1,345 statin-free patients), with a single up-titration at 6 weeks if needed.…”

“…Overall, LDL-C decreased by a mean of 42% in the statin-free group and by an additional 31% (over the statin used at baseline) in the statin-treated group [40,41]. Finally, the ACTFAST studies verified the statin-induced reduction in CRP levels in patients with the MetS [42]. The ACTFAST studies confirmed that a flexible starting dose of atorvastatin allows most patients with type 2 diabetes or the MetS to achieve their LDL-C target safely with the initial dose or just a single titration.…”

Achievement of specified low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol apolipoprotein B, and high-sensitivity C-reactive protein levels with ezetimibe/simvastatin or atorvastatin in metabolic syndrome patients with and without atherosclerotic vascular disease (from the VYMET study)

“…These results are similar to previous reports evaluating the effects of ezetimibe/simvastatin and atorvastatin on hs-CRP reductions in subjects with metabolic syndrome. 13,15,34 Conclusions This post hoc analysis is the first report evaluating the simultaneous achievement of specified LDL-C, non-HDL-C and Apo B levels in individuals with metabolic syndrome with and without AVD. The more efficacious therapies (ezetimibe/simvastatin 10/20-40 and atorvastatin 40 mg) were required for .80% of subjects with MetS with or without AVD to achieve the dual targets of LDL-C ,100 mg/dL and non-HDL-C ,130 mg/dL.…”