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To the Editor: The authors of ALLHAT-LLT¹ only briefly mentioned the anti-inflammatory effect of statins. Both primary and secondary prevention trials^2-4 have found that treatment with statins reduces levels of C-reactive protein (CRP) and cardiovascular risk, with the greatest beneficial effects in individuals with elevated baseline levels of CRP, a marker of inflammation. Furthermore, a recent study⁵ found that CRP level is a stronger predictor of cardiovascular events than low-density lipoprotein cholesterol level. Thus, baseline levels of CRP may have an important role in determining the beneficial effects of statins.

Luca Mascitelli, MD
Casa di Cura "Città di Udine"
Udine, Italy

Francesca Pezzetta, MD
Ospedale San Michele
Gemona del Friuli, Italy

1. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA. 2002;288:2998-3007. FREE FULL TEXT 2. Pasternak RC. The ALLHAT Lipid Lowering Trial: less is less. JAMA. 2002;288:3042-3044. FREE FULL TEXT 3. Ridker PM, Rifai N, Clearfield M, et al. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med. 2001;344:1959-1965. FREE FULL TEXT 4. Ridker PM, Rifai N, Pfeffer MA, et al. Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Circulation. 1998;98:839-844. FREE FULL TEXT 5. Ridker PM, Rifai N, Rose L, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347:1557-1565. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:2071.

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