The class
Unlike statins and ezetimibe, CETP inhibitors show only a slight, non-significant rise in CRP across a 53-trial meta-analysis (Cardiovasc Res 2024)
Original title: Effect of lipid-lowering therapies on C-reactive protein levels: a comprehensive meta-analysis of randomized controlled trials
Because chronic low-grade inflammation is a hallmark of atherosclerotic cardiovascular disease, this meta-analysis assessed the effect of lipid-lowering therapies on C-reactive protein (CRP), an inflammation biomarker, following PRISMA guidelines. Databases were searched through July 2023 for randomized controlled trials with over 100 subjects per arm and intervention duration exceeding 3 weeks, yielding 171 668 subjects from 53 trials. CRP was significantly reduced by statins (-0.65 mg/L), bempedoic acid (-0.43 mg/L), ezetimibe (-0.28 mg/L), and omega-3 fatty acids (-0.27 mg/L), while fibrates produced a non-significant reduction. PCSK9 inhibitors showed a slight significant CRP increase (0.11 mg/L), and CETP inhibitors showed a slight, non-statistically-significant increase of 0.10 mg/L (95% CI 0.00 to 0.21), with meta-regression finding no significant correlation between CRP changes and LDL cholesterol or triglyceride changes across drug classes.
Original abstract
Chronic low-degree inflammation is a hallmark of atherosclerotic cardiovascular (CV) disease. To assess the effect of lipid-lowering therapies on C-reactive protein (CRP), a biomarker of inflammation, we conducted a meta-analysis according to the PRISMA guidelines. Databases were searched from inception to July 2023. Inclusion criteria were: (i) randomized controlled trials (RCTs) in human, Phase II, III, or IV; (ii) English language; (iii) comparing the effect of lipid-lowering drugs vs. placebo; (iv) reporting the effects on CRP levels; (v) with intervention duration of more than 3 weeks; (vi) and sample size (for both intervention and control group) over than 100 subjects. The between-group (treatment-placebo) CRP absolute mean differences and 95% confidence intervals were calculated for each drug class separately. A total of 171 668 subjects from 53 RCTs were included. CRP levels (mg/L) were significantly decreased by statins [-0.65 (-0.87 to -0.43), bempedoic acid; -0.43 (-0.67 to -0.20), ezetimibe; -0.28 (-0.48 to -0.08)], and omega-3 fatty acids [omega3FAs, -0.27 (-0.52 to -0.01)]. CRP was reduced by -0.40 (-1.17 to 0.38) with fibrates, although not statistically significant. A slight increase of CRP concentration was observed for proprotein convertase subtilisin/kexin type 9 inhibitors [0.11 (0.07-0.14)] and cholesteryl-ester transfer protein inhibitors [0.10 (0.00-0.21)], the latter being not statistically significant. Meta-regression analysis did not show a significant correlation between changes in CRP and LDL cholesterol (LDL-C) or triglycerides. Statins, bempedoic acid, ezetimibe, and omega3FAs significantly reduce serum CRP concentration, independently of LDL-C reductions. The impact of this anti-inflammatory effect in terms of CV prevention needs further investigation.
Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.