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High sensitivity C reactive protein as a prognostic marker in patients with mild to moderate aortic valve stenosis during lipid-lowering treatment : an SEAS substudy
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Blyme, Adam (author)
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Asferg, Camilla (author)
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Nielsen, Olav W (author)
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Sehestedt, Thomas (author)
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Kesäniemi, Y Antero (author)
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Gohlke-Bärwolf, Christa (author)
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- Boman, Kurt (author)
- Umeå universitet,Medicin,Skellefteå Research Unit
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- Willenheimer, Ronnie (author)
- Lund University,Lunds universitet,Kardiologiska klinikens forskargrupp,Forskargrupper vid Lunds universitet,Cardiology Research Group,Lund University Research Groups
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Ray, Simon (author)
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Nienaber, Christoph A (author)
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Rossebø, Anne (author)
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Wachtell, Kristian (author)
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Olsen, Michael H (author)
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(creator_code:org_t)
- 2015-02-04
- 2015
- English.
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In: Open heart. - : BMJ. - 2053-3624. ; 2:1
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Abstract
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- AIMS: To assess the prognostic importance of high-sensitive C reactive protein (hsCRP) in patients with mild to moderate aortic valve stenosis during placebo or simvastatin/ezetimibe treatment in Simvastatin and Ezetimibe in Aortic Stenosis (SEAS).METHODS AND RESULTS: In 1620 SEAS patients, we measured lipids and hsCRP at baseline and after 1 year of treatment and registered during 4 years of follow-up major cardiovascular events (MCE) composed of ischaemic cardiovascular events (ICE) and aortic valve-related events (AVE). Simvastatin/ezetimibe reduced low-density lipoprotein cholesterol (3.49 (2.94 to 4.15) to 1.32 (1.02 to 1.69) vs 3.46 (2.92 to 4.08) to 3.34 (2.81 to 3.92) mmol/L) and hsCRP (2.1 (0.9 to 4.1) to 1.2 (0.6 to 2.4) vs 2.2 (0.9 to 4.9) to 1.8 (0.85 to 4.35) mg/L, all p<0.05) during the first year of treatment. In multivariable Cox regression analysis adjusting for traditional risk factors and baseline hsCRP, ICE was associated with a 1-year increase of hsCRP (HR=1.19 (95% CI 1.12 to 1.25), p<0.001) but not with active treatment (HRTreatment=0.86 (0.67 to 1.13), p=0.28). Patients in the top quartile of baseline hsCRP versus the rest were associated with a higher risk of MCE (HR=1.34(1.09 to 1.64), p=0.02). The prognostic benefit of reduction in hsCRP after 1 year was significantly larger (p<0.01 for interaction) in patients with high versus low baseline hsCRP; hence, a reduction in hsCRP abolished the difference in incidence of MCE between high versus low baseline hsCRP in patients with reduced hsCRP (31.1 vs 31.9%, NS) in contrast to patients with increased hsCRP.CONCLUSIONS: The treatment-associated reduction in ICE was in part related to a reduction in hsCRP but not in lipids. hsCRP reduction was associated with less MCE, especially in patients with high baseline hsCRP.TRIAL REGISTRATION: NCT00092677.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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- art (subject category)
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Open heart
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- By the author/editor
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Blyme, Adam
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Asferg, Camilla
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Nielsen, Olav W
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Sehestedt, Thoma ...
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Kesäniemi, Y Ant ...
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Gohlke-Bärwolf, ...
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show more...
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Boman, Kurt
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Willenheimer, Ro ...
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Ray, Simon
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Nienaber, Christ ...
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Rossebø, Anne
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Wachtell, Kristi ...
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Olsen, Michael H
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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Open heart
- By the university
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Umeå University
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Lund University