Arévalo-Lorido José Carlos
a Internal Medicine Service, Zafra County Hospital , Badajoz , Spain.
Ann Med. 2016 Nov;48(7):516-524. doi: 10.1080/07853890.2016.1197413. Epub 2016 Jun 29.
The role of statins in the protection of atherosclerosis and reducting cardiovascular (CV) events is well established. On the other hand, the role of inflammation in the propagation and propensity to CV events has also been demonstrated. High-sensitivity C-reactive protein (CRP) which is involved in the immunologic process of inflammation has received the interest for its use in screening and risk reclassification. However, evidence for its causal relationship with atherothrombosis is lacking, and even more, knowing that statins influence on the reduction of CRP levels, a relevant evidence of their clinical benefits in this regard is also lacking. This article reviews four different key points regarding the issue, to better understand the current state and application of the treatment with statins in order to achieve benefits from lowering CRP's levels regarding CV diseases: (1) the mechanisms of reduction of CRP levels by statins; (2) the role of statin-mediated CRP reduction in the atherosclerotic plaque regression; (3) the role in the prevention of CV diseases; and (4) the role in case of secondary prevention. With this basis, the reduction of CRP levels should be interpreted as a reduction of inflammatory burden thus its clinical benefits could be more interesting in secondary prevention. KEY MESSAGES It could be admitted a role of statin-mediated CRP diminution to reduce the rate of progression in atherosclerotic plaque. In general, and in the absence of specific clinical trials, the role of statins by lowering CRP and consequently, preventing cardiovascular events may be superior in case of secondary prevention because a more pronounced state of inflammation and regardless of its levels at baseline.
他汀类药物在预防动脉粥样硬化和减少心血管（CV）事件方面的作用已得到充分证实。另一方面，炎症在心血管事件的发生发展及易感性方面的作用也已得到证实。参与炎症免疫过程的高敏C反应蛋白（CRP）因其在筛查和风险重新分类中的应用而受到关注。然而，缺乏其与动脉粥样硬化血栓形成因果关系的证据，更有甚者，鉴于他汀类药物对降低CRP水平有影响，在这方面其临床益处的相关证据也不足。本文综述了关于该问题的四个不同要点，以便更好地理解他汀类药物治疗的现状和应用，从而在降低CRP水平以预防心血管疾病方面获得益处：（1）他汀类药物降低CRP水平的机制；（2）他汀类药物介导的CRP降低在动脉粥样硬化斑块消退中的作用；（3）在预防心血管疾病中的作用；（4）在二级预防中的作用。在此基础上，CRP水平的降低应被解释为炎症负担的减轻，因此其临床益处可能在二级预防中更具意义。关键信息 可以承认他汀类药物介导的CRP降低在降低动脉粥样硬化斑块进展速率方面的作用。一般来说，在缺乏具体临床试验的情况下，他汀类药物通过降低CRP从而预防心血管事件的作用在二级预防中可能更显著，因为炎症状态更明显，且与基线水平无关。
