For co-author Douglas Owens, MD, the study points to a high priority for determining whether statins work as well in low-risk people (i.e. those with normal CRP levels) or just high-risk ones. "That's a big uncertainty," he said, and the answer would inform how cost-effective both screening and broad therapy are.
The researchers also said it would be important to know whether high CRP levels do more than identify people who are at risk of developing heart disease, but also identify which people are more likely to have lower risk of heart attack or stroke when treated with a statin. (The test could then spare certain patients from unnecessary treatment.)
"Ideally, a marker would tell us who will benefit from drug treatment and who will not," said Hlatky. "If a test could give us that information, it would be very cost-effective. But there's not good evidence yet that CRP, or any other test, works that well."
Hlatky said a National Heart, Lung, and Blood Institute working group is now updating the clinical guidelines for statin therapy, and he hopes this research will inform their recommendations. "Maybe the threshold for statin treatment ought to be lower than is currently recommended," he said.
In the meantime, the researchers have developed an interactive tool that physicians can reference to determine the most cost-effective approach to statin therapy for individual patients. The calculator can be found at http://med.stanford.edu/hsr/crp-screening/
|Contact: Michelle Brandt|
Stanford University Medical Center