Nissen and his colleagues used the same two drugs in a study of patients with chronic heart disease who had not had a heart attack. They obtained similar results, showing that the greatest reduction in risk of a heart attack was among patients with the greatest reduction in both LDL and CRP.
In the patients with the greatest lowering of cholesterol and CRP, the researchers actually saw a regression of plaque in the coronary arteries, indicating that the disease process had been reversed.
"We must now begin to think of CRP as an accelerator of disease activity, not just a marker associated with high risk," Nissen said.
"These are very compelling, very important studies," said Dr. Sidney Smith of the University of North Carolina at Chapel Hill, the chief scientific advisor for the American Heart Assn. "The real question now is: How do we take this information and couple it with therapeutic strategies?"
Ridker and Nissen indicated that a first step was to increase the dosage of a patient's statin when possible.
The studies looked at statin dosages as high as 80 milligrams, about twice the normally prescribed dose.
Long-term use of statins has been associated with a risk of liver and muscle damage that increases with dose. The new studies found a small increase in risk of such damage associated with the higher doses, but the overall risk was small compared to the heart attack risk.
"There is a very powerful benefit-to-risk ratio," Nissen said.
If increasing the dose doesn't work, changing statins also is a possibility.
"All statin drugs lower CRP," Ridker said, but individual patients often responded better to one drug than to another.
The new findings are certain to accelerate the search for other drugs that can reduce arterial inflammation.
Nissen is already testing some diabetes drugs that seem to have a beneficial effect, and some experts have speculated that the benefits of daily doses of aspirin in heart patients may arise, in part, from its effects on inflammation.
