Changes In hsCRP Levels Research Articles

Effects of Colesevelam Hydrochloride on Low-Density Lipoprotein Cholesterol and High-Sensitivity C-Reactive Protein When Added to Statins in Patients With Hypercholesterolemia

Elevated high-sensitivity C-reactive protein (hs-CRP) levels are associated with an increased risk of atherosclerotic coronary heart disease (CHD). The addition of the bile acid sequestrants, such as colesevelam hydrochloride (HCl), to statins further reduces low-density lipoprotein (LDL) cholesterol levels. However, the effects of approved cholesterol-lowering bile acid sequestrants on hs-CRP have not previously been reported. Three randomized, double-blind, placebo-controlled, parallel, 6-week clinical trials of similar design investigated the efficacy of adding colesevelam HCl to stable simvastatin, atorvastatin, or pravastatin treatment in 204 patients with primary hypercholesterolemia. The primary end point was the mean percent change in the LDL cholesterol levels. Secondary end points included the effects on other lipid parameters and hs-CRP levels. A pooled analysis showed that adding colesevelam HCl to statin therapy significantly lowered LDL cholesterol levels (21 mg/dl or 16% mean reduction from baseline, p = 0.0013, and 11 mg/dl or 9% mean reduction compared with placebo, p = 0.0003). Four times as many patients receiving colesevelam HCl plus a statin achieved a LDL cholesterol target of <100 mg/dl compared with patients receiving a statin plus placebo (39% vs 10%, respectively, p <0.0001). The incidence of mild gastrointestinal adverse effects was slightly higher in the colesevelam HCl plus statin group than in the placebo plus statin group. Finally, the differences in the change in hs-CRP levels with colesevelam HCl plus statin therapy were significant compared with the changes with placebo plus statin (median change -23%, p = 0.0069). In conclusion, this is the first report suggesting that an approved cholesterol-lowering bile acid sequestrant, specifically colesevelam HCl, decreases hs-CRP levels when added to statin therapy.

Rosiglitazone lowers C-reactive protein levels in hypertensive type 2 diabetic patients

Accumulating data indicate that thiazolidinediones (TZD) present beneficial effects for the cardiovascular system beyond glycemic control, such as triglyceride reduction, HDL-cholesterol elevation and decrease in plasminogen activator inhibitor-1 levels. The aim of this study was to determine the effect of rosiglitazone on C-reactive protein, an inflammation marker associated with an increased risk for cardiovascular disease, in patients with hypertension and Type 2 diabetes. A total of 40 Type 2 diabetic subjects, already on 15 mg glibenclamide daily, but with a poor glycemic control, were included in the study. Patients had either established hypertension, poorly controlled under antihypertensive treatment, or newly diagnosed mild hypertension without medication. In 20 of the subjects rosiglitazone 4 mg daily was added-on therapy for 26 weeks, while the rest remained only with the preexisting treatment to serve as control group. At baseline and the end of the study subjects gave blood samples where high sensitive C-reactive protein (hs-CRP) was measured with the use of a latex-enhanced immunonephelometric method. At the end of the study, rosiglitazone treatment was associated with a significant reduction in hs-CRP levels versus baseline (from 0.53±0.11 to 0.39±0.12 mg/dL, P<0.05). In contrast, no significant change in hs-CRP levels was observed in the control group (from 0.49±0.19 to 0.56±0.09 mg/dL, P=0.18). Between-groups comparison revealed also a significant difference for hs-CRP (P<0.05). If the rosiglitazone group is divided in subgroups of men (n=9) and women (n=11), or patients with (n=10) and without (n=10) preexisting antihypertensive treatment, a downward trend in hs-CRP levels is still observed in the subgroups, but the reduction is significant only in that of patients without antihypertensive treatment. Treatment of hypertensive Type 2 diabetic patients with rosiglitazone resulted in a significant reduction of hs-CRP levels. This finding indicates that rosiglitazone possibly exerts a vasculoprotective action, which may be important for this type of patients, who are in high risk for atherosclerotic complications.

Effect of Exercise on Serum C-Reactive Protein

Background and Objectives:Regular exercise protects us against numerous chronic diseases, and reduces the risk of cardiovascular disease. Also, C-reactive protein, a marker of inflammation, is known to be associated with the risk and prognosis of cardiovascular disease. The present study was designed to assess the effects of regular exercise on the level of high sensitive C-reactive protein (hsCRP). Subjects and Methods:The serum level of hsCRP and the anthropometric indices of adiposity, metabolic variables, blood pressure (BP) and several cardiovascular risk factors were measured in 18445 subjects. A prospective study of 42 subjects with high baseline levels of hsCRP was conducted. After 3 months of regular aerobic exercise their hsCRP levels were rechecked and the association between regular exercise and hsCRP analyzed using a cross sectional and prospective study. Results:Age, smoking, hypertension, diabetes and body mass index were found to be independent determinants of an elevated hsCRP level, but exercise was not found to be associated with a decreased hsCRP level in the cross-sectional study. In the prospective study, the mean serum hsCRP value was significantly reduced after 3 months in the exercise group (3.02±1.06 vs. 2.05±1.23 p=0.015), but not in the controls (3.03±1.09 vs. 2.57±1.11 p=0.104). However, the interval changes in hsCRP levels were not different in the exercise compared to the control group (p=0.660). Conclusion:These results suggest that exercise is not an independent determinant of the CRP level. Three months of regular aerobic exercise show a tendency to be associated with a reduction in the hsCRP level, but this putative effect of exercise on the hsCRP level was not significant in healthy subjects. Further larger sample, prospective cohort studies will be required to establish the effect of exercise on the hsCRP level. (Korean Circulation J 2005;35:533-538)