Trial reportDiabetologia2015
Effect of atorvastatin on C-reactive protein and benefits for cardiovascular disease in patients with type 2 diabetes: analyses from the Collaborative Atorvastatin Diabetes Trial.
Trial report in Diabetologia, 2015. The graph read 3 numbers from its abstract, feeding 2 cells of the map, but it casts no vote: the report of the main result of NCT00327418 is not on the map. It reports registered trial NCT00327418. Cited by 19 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
Ratios
Stratified by treatment group, there was a weak, non-significant association (HR 1.17 [95% CI 0.94, 1.45]) between baseline CRP (per 1 SD in loge CRP) and incidence of any CVD event in the atorvastatin group only, whereas in the placebo group the HR was 0.95 (95% CI 0.80, 1.13) after adjustment for other covariates beyond age and sex.
Differences
RESULTS: After 1 year, the atorvastatin arm showed a net CRP lowering of 32% (95% CI -40%, -22%) compared with placebo.
Read, but not usablea number the graph found but could not read as for or against
By comparison, atorvastatin reduced LDL-cholesterol levels by 42% (p < 0.0001) from baseline to 1 year.
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Where it lands on the map
Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.
What it adds to each cell
For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.
Statins×inflammation & biomarkers
Does not voteOpen on the map →What to test next →7 readable studies in this cell: 2 favour the treatment, 4 find no difference, 1 favour the comparator.
This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.
Statins×lipids
No readable resultOpen on the map →What to test next →38 readable studies in this cell: 26 favour the treatment, 5 find no difference, 7 favour the comparator.
This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Double Blind Placebo Controlled Study of Atorvastatin as Prevention of CHD in High Risk Patients With Non-Insulin Dependent Diabetes Mellitus (Collaborative Atorvastatin Study - CARDS)
Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Effect of atorvastatin on testosterone levels.The Cochrane database of systematic reviews · 2021Pooled it
- Association Between Baseline, Achieved, and Reduction of CRP and Cardiovascular Outcomes After LDL Cholesterol Lowering with Statins or Ezetimibe: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2019 · on this mapPooled it
- High-sensitivity C-reactive protein, low-density lipoprotein cholesterol and cardiovascular outcomes in patients with type 2 diabetes in the EXAMINE (Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care) trial.Diabetes, obesity & metabolism · 2018Trial
- The Effect of Statins on Carotid Intima-Media Thickness and C-Reactive Protein in Type 2 Diabetes Mellitus: A Meta-Analysis.Journal of cardiovascular development and disease · 2024Review
- [C-reactive protein, cardiovascular issues of an acute-phase protein: an update for theclinician].Archivos de cardiologia de Mexico · 2024Review
- C-Reactive Protein: The Quintessential Marker of Systemic Inflammation in Coronary Artery Disease-Advancing toward Precision Medicine.Biomedicines · 2023Review
- Statin Prescription Patterns and Associations with Subclinical Inflammation.Medicina (Kaunas, Lithuania) · 2022Article
- Article
- Kynurenine Pathway Metabolites in the Blood and Cerebrospinal Fluid Are Associated with Human Aging.Oxidative medicine and cellular longevity · 2022Article
- Clinical approach to the inflammatory etiology of cardiovascular diseases.Pharmacological research · 2020Review
- Cholesterol-Lowering Treatment in Chronic Kidney Disease: Multistage Pairwise and Network Meta-Analyses.Scientific reports · 2019Article
- Cardiovascular Risk Estimated by UKPDS Risk Engine Algorithm in Diabetes.Open medicine (Warsaw, Poland) · 2018Article
- Targeting inflammation to reduce cardiovascular disease risk: a realistic clinical prospect?British journal of pharmacology · 2017Review
- Vascular inflammation and low-density lipoproteins: is cholesterol the link? A lesson from the clinical trials.British journal of pharmacology · 2017Review
- Prognostic Importance of C-Reactive Protein in High Cardiovascular Risk Patients With Type 2 Diabetes Mellitus: The Rio de Janeiro Type 2 Diabetes Cohort Study.Journal of the American Heart Association · 2016Observational
- Applying metabolomics to cardiometabolic intervention studies and trials: past experiences and a roadmap for the future.International journal of epidemiology · 2016Review
- Efficacy of atorvastatin in prevention of atrial fibrillation after heart valve surgery in the PROFACE trial (PROphylaxis of postoperative atrial Fibrillation After Cardiac surgEry).Journal of arrhythmia · 2016Article
- Trial of Atorvastatin on Serum Interleukin-6, Total Antioxidant Capacity, C-Reactive Protein, and Alpha-1 Antitrypsin in Patients with Chronic Obstructive Pulmonary Disease.Journal of research in pharmacy practiceArticle
- Changes in C-reactive protein in response to anti-inflammatory therapy as a predictor of cardiovascular outcomes: A systematic review and meta-analysis.JRSM cardiovascular diseaseArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The marked sentences are the ones the graph read a number from.
aims/hypothesisWe investigated whether atorvastatin 10 mg daily lowered C-reactive protein (CRP) and whether the effects of atorvastatin on cardiovascular disease (CVD) varied by achieved levels of CRP and LDL-cholesterol.
methodsCRP levels were measured at baseline and 1 year after randomisation to atorvastatin in 2,322 patients with type 2 diabetes (40-75 years, 69% males) in a secondary analysis of the Collaborative Atorvastatin Diabetes Study, a randomised placebo-controlled trial. We used Cox regression models to test the effects on subsequent CVD events (n = 147) of CRP and LDL-cholesterol lowering at 1 year.
resultsAfter 1 year, the atorvastatin arm showed a net CRP lowering of 32% (95% CI -40%, -22%) compared with placebo. The CRP response was highly variable, with 45% of those on atorvastatin having no decrease in CRP (median [interquartile range, IQR] per cent change -9.8% [-57%, 115%]). The LDL-cholesterol response was less variable, with a median (IQR) within-person per cent change of -41% (-51%, -31%). Baseline CRP did not predict CVD over 3.8 years of follow-up (HRper SD log 0.89 [95% CI 0.75, 1.06]), whereas baseline LDL-cholesterol predicted CVD (HRper SD 1.21 [95% CI 1.02, 1.44]), as did on-treatment LDL-cholesterol. There was no significant difference in the reduction in CVD by atorvastatin, with above median (HR 0.57) or below median (HR 0.52) change in CRP or change in LDL-cholesterol (HR 0.61 vs 0.50). CONCLUSIONS/
interpretationCRP was not a strong predictor of CVD. Statin efficacy did not vary with achieved CRP despite considerable variability in CRP response. The use of CRP as an indicator of efficacy of statin therapy on CVD risk in patients with type 2 diabetes is not supported by these data. Trial registration NCT00327418.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.