C-reactive protein, CRP, and extension of the clinical uses of rosuvastatin, Crestor*.

C-reactive protein, CRP, is a protein synthesized by the liver and released in plasma. Its plasma concentration which normally is around 1 mg per liter raises considerably during inflammatory diseases and slightly, around 3 to 5 mg per liter, in people at risk of cardiovascular events, including strokes, and different cancers.

There are two methods for CRP determination: a standard one measuring levels higher than 5 mg per liter used in inflammatory diseases and a high sensivity one  measuring values lower than 5 mg per liter used for cardiovascular risk assessment in persons without inflammatory syndrome.

A meta-analysis published in Lancet of January 9th, 2010 shows schematically that a concentration of CRP higher than 2 mg per liter corresponds to an increase in the cardiovascular risk. Note however that the concentration of CRP rises gradually with age to approach 2 mg around 75 years.

The Jupiter study focused the attention on CRP: indeed, people included in this trial were selected not for a high LDL-cholesterol but for a CRP higher than 2 mg per liter. Rosuvastatin, 20 mg daily, compared to placebo, gave beneficial effects and relatively little adverse effects (except a possible increase in the frequency of diabetes). These results led the FDA to extend the clinical indications of rosuvastatin, Crestor*, to people of more than 50 years for men and 60 years for women, having a CRP higher  than 2 mg per liter and another risk factor (arterial hypertension, low HDL-cholesterol, smoker, heredity of cardiovascular accidents).

Is rosuvastatin a statin different from the others?  What would be obtained with a lower dose, for example 5 mg daily?