Reduction In hs-CRP Research Articles

THE EFFECTS OF LOW-DOSE ROSUVASTATIN ALONE OR IN COMBINATION WITH FENOFIBRATE OR OMEGA 3 FATTY ACIDS IN MIXED DYSLIPIDEMIA

Objective Mixed dyslipidemia is characterized by elevated cholesterol and triglycerides. Indians have high prevalence of this pattern. The aim of present study was to evaluate the effects of rosuvastatin and in combination with fenofibrate or omega-3-FAs on lipids and hsCRP. Methods This was an open-label randomized study. Patients were allocated to low-dose rosuvastatin(R), rosuvastatin plus fenofibrate (RF) or rosuvastatin plus omega-3-FA(RO). At 6-weeks and 12-weeks follow-up, lipid lowering effect and change in hsCRP was studied. Results The study involved 105 participants (M/F=68/37) with a mean age of 57±13 years. At end of 6 and 12-weeks, there was significant reduction in TC, LDL-C, TG and hsCRP in all treatment groups, but increase in HDL-C became significant at 12-weeks. Percentage reduction in TC was 21%vs17%vs23% at 6-weeks and 31%vs37%vs35% at 12-weeks in group R, RF and RO, respectively. At 12-weeks, reduction in LDL-C was 22% in R vs 45% in RF vs 18% in RO and increase in HDL-C was 3.8% in R vs 7.6% in RF vs 15.8% in RO. Percentage reduction in triglycerides was 18%vs31% vs30% at 6 weeks and 23%vs52%vs51% at 12-weeks. Conclusion The mixed dyslipidemic patients responded well in terms of significant reduction in TC, LDL-C, and improving HDL-C and inflammation across all study groups. However, combination of low-dose-rosuvastatin plus fenofibrate or omega-3-FAs had more potent effect in reducing triglycerides and also in percentage increase in HDL-C, when compared with rosuvastatin alone. Omega-3 FAs, therefore, seem to be an attractive alternative to fibrates in patients with mixed dyslipidemia.

Anti-inflammatory effects of rosuvastatin treatment on coronary artery ectasia patients of different age groups

BackgroundCoronary artery ectasia (CAE) is an angiographic finding of abnormal coronary dilatation. Inflammation plays a major role in all phases of atherosclerosis. We investigated the relationship between CAE and serum high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels to test our hypothesis that patient age is associated with the efficacy of anti-inflammatory therapy for CAE.MethodsWe conducted a prospective analysis of 217 patients with CAE treated at the Department of Cardiology, Shanghai East Hospital, Ji’an Campus and the Baoshan People’s Hospital, from January 1, 2015 to July 30, 2019. Baseline data of patients, including sex; age; and history of hypertension, hyperlipidemia, and diabetes, were collected from patient medical records. Study participants were grouped by age as follows: CAE-A (n = 60, age ≤ 50 years), CAE-B (n = 83, 50 years <age ≤ 70 years), and CAE-C (n = 74, age > 70). Additionally, there was a control (NC) group (n = 73) with normal coronary arteries.ResultsAll patients received oral rosuvastatin therapy (10 mg, QN quaque nocte) when they were diagnosed with CAE and maintained good follow-up, with a loss rate of 0.0% at the end of the 6-month follow-up. The NC group received regular symptom-relieving treatments and rosuvastatin therapy. Of these four groups, the inflammatory markers, hs-CRP and IL-6, were significantly higher in patients with CAE than in the NCs (p < 0.05). Post-hoc tests showed that hs-CRP and Il-6 levels had significant differences between the CAE-A and CAE-C groups (P = 0.048, P = 0.025). Logistic regression analysis showed that hs-CRP (OR = 1.782, 95% CI: 1.124–2.014, P = 0.021) and IL-6 (OR = 1.584, 95% CI: 1.112–1.986, P = 0.030) were independent predictors of CAE. The inflammatory markers were higher in the CAE-A group than in the CAE-B group and higher in the CAE-B group than in the CAE-C group. Follow-up after 6 months of rosuvastatin therapy showed a significantly greater reduction in hs-CRP and IL-6 levels in the CAE-A group than in the CAE-B group, which again were greater in the CAE-B group than in the CAE-C group.ConclusionsAnti-inflammatory therapy using rosuvastatin was more effective in younger CAE patients, indicating the need for early statin therapy in CAE.

Effect of Vitamin D Supplementation on Inflammatory Markers in Non-Obese Lebanese Patients with Type 2 Diabetes: A Randomized Controlled Trial.

Background: A low serum 25-hydroxyvitamin D (25(OH) D) concentration has been associated with a higher risk of type 2 diabetes mellitus (T2DM), especially in older people. Our aim in this randomized controlled trial was to evaluate the effect of vitamin D treatment on inflammatory markers in non-obese Lebanese patients with T2DM, living in Beirut, Lebanon. Methods: Non-Obese patients with T2DM (n = 88), deficient/insufficient in vitamin D, were randomly assigned into one of two groups—a treatment group receiving 30,000 IU cholecalciferol/week for a period of six months, and a placebo group. Serum concentrations of TNF-α, high-sensitivity C-reactive protein (hs-CRP), and Interleukin-6 (IL-6) were the primary outcomes. A homeostatic model of insulin resistance (HOMA-IR) was assessed, in addition to serum concentrations of fasting blood glucose (FBG), HbA1C, (25(OH) D), and PTH. Results: The vitamin D group showed higher blood levels of (25(OH) D) (p < 0.0001), and a significant reduction in hs-CRP and TNF-α concentrations (p < 0.0001) compared to placebo. The decrease perceived in IL-6 concentrations was not significant (p = 0.1). No significant changes were seen in FBG (p = 0.9) and HbA1c levels (p = 0.85). Conclusion: Six months of vitamin D supplementation led to a decrease in some inflammatory markers in patients with T2DM. Additional studies with a larger sample and a longer period are advised in this regard. This trial was registered at ClinicalTrial.gov; Identifier number: NCT 03782805.

The Impact of an Optimism Training Intervention on Biological Measures Associated With Cardiovascular Health: Data From a Randomized Controlled Trial.

Positive psychological constructs, such as optimism, are associated with cardiovascular health, and changes in biological measures associated with heart health have been proposed as potential mediators of these relationships. In this analysis of data from a randomized controlled trial, we examined the impact of an optimism training intervention on biological measures associated with cardiac health in patients with coronary artery disease. We analyzed data from an 8-week, randomized, controlled trial of a group-based optimism training intervention in 61 patients with coronary artery disease. High-sensitivity C-reactive protein (hs-CRP), interleukin 6, irisin, and fibrinogen were measured at baseline, 8 weeks, and 16 weeks. Mixed-effects regression analyses were performed to examine the effects of the intervention on changes in biological measures at 8 and 16 weeks. At 8 weeks, the intervention led to significantly greater reductions in hs-CRP (B = -0.851 [standard error {SE} = 0.273, p = .002) and fibrinogen (B = -0.148 [SE = 0.062], p = .016), and a greater increase in irisin (B = 0.252 [SE = 0.114], p = .027) compared with the control condition. These changes persisted at 16 weeks (hs-CRP: B = -1.078 [SE = 0.276], p < .001; fibrinogen: B = -0.270 [SE = 0.062], p < .001; irisin: B = 0.525 [SE = 0.116], p < .001), and interleukin 6 additionally was impacted at this time point (B = -0.214 [SE = 0.064], p = .001). Exploratory mediation analyses failed to identify significant psychological or health behavior mediators of these relationships. A group-based optimism training intervention resulted in significant, robust, and sustained changes in biological measures associated with cardiac health. Further studies are needed to confirm these findings in a larger sample and identify potential mediating variables. Iran Registry of Clinical Trials No. 2016070328769 N1.

Reduction in Serum High-Sensitivity C-Reactive Protein Favors Kidney Outcomes in Patients with Impaired Fasting Glucose or Diabetes

Objective We aimed to evaluate whether the reduction in serum high-sensitivity C-reactive protein (hs-CRP) favors kidney outcomes. Methods This study was a subanalysis including patients with impaired fasting glucose or diabetes of the Kailuan cohort study. The predictor was based on two consecutive visits of hs-CRP levels in 2006 and 2008. A total of 3924 patients with hs-CRP ≥ 3 mg/L in 2006 were divided into two groups according to whether the levels of hs-CRP were reduced in 2008: Group 1: no reduction: hs-CRP ≥ 3 mg/L in 2008; Group 2: reduction: hs-CRP < 3 mg/L in 2008. Kidney outcomes include kidney function decline and development and progression of proteinuria and were followed up until the end of 2015. Results There were 3905, 2049, and 493 patients included into our analysis for the outcomes of kidney function decline and the development and progression of proteinuria, respectively. A total of 398, 297, and 47 events occurred after 5 years of follow-up, respectively. Cox regression revealed that patients with reduction in hs-CRP have lower risk of kidney function decline (HR 0.71, 95% CI 0.57-0.89, and P = 0.002) and development of proteinuria (0.77, 0.61-0.99, and P = 0.038) after controlling for potential confounders as compared to those with no reduction in hs-CRP levels. Conclusions Reduction in serum hs-CRP levels favors kidney outcomes in patients with impaired fasting glucose or diabetes.

2219-PUB: Comparison of Efficacy of Canagliflozin 100mg vs. Canagliflozin 300mg on hs-CRP in Patients with Type 2 Diabetes Mellitus

Aim: To compare the efficiency of canagliflozin (C1) 100mg vs. canagliflozin (C3) 300mg on highly sensitive C reactive protein (hs-CRP) and other cardio-renal (CR) biomarkers. Methodology: Between July and Sept 2018, a cohort of 190 T2DM patients aged 18-75 yrs, irrespective of baseline A1c, receiving SGLTi C1 or C3 were identified. A propensity score 1:1 matching was done for both the groups with variables that could affect treatment outcomes and to minimise confounding. Patients were evaluated every 2-3months for CR biomarkers (body mass index (BMI), A1c, systolic (S) BP, diastolic (D) BP, Lipid profile (TC, LDL, TG, HDL), Hs-CRP, creatinine, eGFR and urinary albumin/creatinine ratio {UACR}). NT-ProBNP was evaluated at 12 months. T2DM with history of IHD, revasularisation, major surgery, hyperkalemia &amp;gt;5.5Meq/L and eGFR&amp;lt;45 were excluded. Baseline characteristics were analyzed using descriptive statistics expressed as % or mean±SD. Comparison between the groups was performed using paired and unpaired t-test expressed as mean ± SE and p value &amp;lt;0.05 was considered significant(S). For interaction between drug class, ANOVA was used. Results: 44 patients were identified in C1 gr and 44 in C3 gr. Baseline characters were well matched in both gr except, SBP (mean±SD) (C1 129.05±17.54 vs. C3 138.05±22.22, P-0.38).C1 gr (baseline to 12m): there was a S reduction in hs-CRP, A1c, BMI, SBP, DBP, TC, TG, LDL. C3 gr (baseline to 12m): there was a S reduction in hs-CRP, A1c, BMI, SBP, DBP, TC, LDL. Difference between C1 and C3 at 12m: There was no difference in hs-CRP mg/L {C1 1.88±0.43 vs. C3 1.31±0.46, p-0.371}, A1c% {C1 1.27±0.19 vs. C3 1.44±0.34, p-0.666}, BMI kg/m2 {C1 1.24±0.27 vs. C3 1.23± 0.25, p-0.988}, NT-ProBNP pg/ml {C1 63.95±65.52 vs. C3 61.53±61.71, p-0.864} eGFR {C1 6.39±3.37 vs. C3 0.99±3.20, p-0.952}, UACR mg/gm {C1 25.48±10.86 vs. C3 9.61±7.87, p-0.240}, Lipid profile, SBP and DBP between both gr. Conclusion: Canagliflozin 100mg is as good as canagliflozin 300mg in reduction of hs-CRP and CR markers. Disclosure V. Gupta: None. V. Teli: None. A. Patel: None.

1069-P: Effect of Sacubitril/Valsartan Combination Therapy in Type 2 Diabetes Mellitus Patients with Elevated NT-proBNB and Preserved Ejection Fraction

Aim: study the effect of Sacubitril/valsartan (SV) combination therapy on cardio-renal (CR) biomarkers in T2DM with preserved ejection fraction (pEF); diastolic dysfunction and or LVH on 2D echocardiogram (E) and elevated N-terminal prohormone B-type natriuretic peptide (NT-proBNP) &amp;gt;125. Methodology: between July and Sept 2018, 109 T2DM patients aged 18-75 yrs, irrespective of baseline A1c, receiving SV were identified. Patients were analysed every 2-3months for CR biomarkers (body mass index (BMI), A1c, systolic (S) BP, diastolic (D) BP, Lipid profile (TC, LDL, TG, HDL), Hs-CRP, NT-ProBNP, creatinine, eGFR and microalbumin/creatinine ratio {UACR} and data presented at 1 yr. T2DM with H/O IHD, reduced EF(&amp;lt;50%) or wall motion abnormalities on E, malignancy, major surgery, hyperkalemia &amp;gt;5.5Meq/L and eGFR&amp;lt;45 were excluded. Baseline characteristics were analyzed using descriptive statistics. Continuous variables were analysed using paired and unpaired t-test expressed as mean ± standard error. For interaction between drug class, ANOVA was used and p value &amp;lt;0.05 was considered significant (S). Results: Baseline characteristics: Male 43%, Female 66%. Avg (age 63.16 ±8.325yrs, BMI 30.45±5.52, A1c% 7.1±1.2, egfr 90.31±30.45, UACR mg/gm 180.07±553.4, hs-CRP mg/dl 2.53±3.41, NT-proBNP 370.07±543.30 Ng/L). 64.2% received canagliflozin, 11.9% liraglutide, 94.5% Metformin, 61.5% gliptins, 65.1% gliclazide, 44% calcium channel blockers and 100% statin (rosuvastatin) Baseline (B) to 1yr: There was S reduction in SBP, DBP, A1c, TC, LDL, HDL, UACR, hs-CRP and NT-ProBNP NT-proBNP: there was S reduction from B to 3 mths (84.26±31.86, p-0.009), 6mth - 12 mths (39.95±17.40,p-0.024) and B-12mths (155.69±744.10,p-0.001). There was no diff seen 3-6mths (38.09±38.03, p-0.320). There was an interaction seen with Liraglutide in terms of NT-proBNP and UACR. Conclusion: SV may be effective in reducing NT-ProBNP in T2DM with pEF Disclosure V. Gupta: None. V. Teli: None.

SUN-607 Iron Parameters in Patients with Partial Lipodystrophy and Impact of Metreleptin Therapy

Introduction Intriguing rodent studies and epidemiological data suggest that iron metabolism and adipocytokines crosstalk to regulate glucose metabolism and fuel storage. Iron parameters have not been previously studied in patients with lipodystrophy whereas increased iron stores have been associated with type 2 diabetes. In this study, we sought to investigate the status of iron parameters in patients with partial lipodystrophy (PL) and to interrogate whether the adipocyte hormone leptin can modulate iron metabolism. Methods Serum samples of 19 patients with PL (age: 42, IQR: 34-57, M/F: 3/16) were used from an open-label study previously performed at the University of Michigan evaluating the efficacy of metreleptin in nonalcoholic steatohepatitis (NCT01679197) to measure ferritin, hepcidin, iron, and transferrin soluble receptor levels. High-sensitivity C-reactive protein (hs-CRP) levels were also determined as broader changes in inflammatory pathways may potentially impact circulating ferritin levels. Results were integrated into an existing database of metabolic parameters. Data are presented as median, IQR. Results At baseline, ferritin levels were positively correlated with fasting glucose (r = 0.533; p = 0.023) and HbA1c (r = 0.510; p = 0.031). During the 6 months of therapy period, HbA1c (9.2%, 7.3-10.3 vs. month-3: 8.6%, 7.7-9.6; p = 0.099; and month-6: 8.5%, 6.8-9.5; p = 0.264), triglyceride levels (346 mg/dL, 240-1771 vs. month-3: 346 mg/dl, 237-479; p = 0.047; and month-6: 295 mg/dl, 207-495; p = 0.091), and hepatic fat (12.7%, 9.8-20.6 vs. month-6: 8.9%, 7.0-11.0; p = 0.031)} decreased. Reductions were observed in serum ferritin after metreleptin treatment (83.23 ng/mL, 76.43-178.97 vs. month-3: 73.79 ng/ml, 68.30-78.59; p = 0.007; and month-6: 61.03 ng/mL, 46.45-157.74; p = 0.004). There was a tendency for hepcidin and iron to be decreased, but this did not reach statistical significance. On the other hand, there were notable reductions in hs-CRP levels at 6 months compared to baseline (2.94 mg/L, 1.30-4.80 vs. 1.6 mg/L, 1.00-6.30; p = 0.012). Baseline leptin level was inversely correlated with percent reduction in hs-CRP at month-6 (r = -0.685; p = 0.001). Also, modest correlations were observed between changes in serum iron and triglycerides (r = 0.491, p = 0.033) and hepatic fat (r = 0.412, p = 0.079). Conclusions We observed a significant relationship between ferritin and glucose control in a group of patients with PL. Metreleptin therapy was associated with improvements in triglycerides and hepatic fat and there were also significant decreases in ferritin and hs-CRP levels. These results raise the possibility that metreleptin therapy influences iron metabolism. However, whether the decrease in ferritin indicates a decrease in iron stores or is mediated by an effect on inflammation remains unknown.

Effect of Moringa oleifera Leaf Extract on High Sensitivity C-Reactive Protein, ESR And MEX SLEDAI Score in Lupus Patients

Introduction: No definitive treatment is available for SLE. Moringa oleifera Leaf Extract is one of promising novel treatments in SLE because of anti inflammatory and immunomodulatory effect. Our study aimed to identify the effect of Moringa oleifera Leaf Extract on the level of hs-CRP, ESR and MEX SLEDAI score in lupus patients. HsCRP and ESR levels are related to the pathogenesis of SLE and they are positively correlated with the disease activity. The MEX SLEDAI score is a simple method that is quite valid for finding the degree of SLE activity, and MEX SLEDAI has the ability to evaluate clinical changes in SLE patients.Methods: Experimental study consisted of 29 samples of SLE patients, divided into 2 groups, namely 13 SLE patients who received Moringa oleifera leaf extract as much as 40.5 mg / kg per day and 16 SLE patients who received placebo. The study was conducted for 28 days. MEX SLEDAI scores, hsCRP and ESR levels were measured before and after administration of therapy. Statistical analysis was applied using SPSS 23, with different t-test, Mann Whitney, and Will Coxon tests. P is significant if p &lt;0.05.Result: Result of the study showed that before Moringa oleifera leaf extract was given, the average MEX SLEDAI score was (1.56 ± 2.16) for control, and (2.69 ± 3.01) for treatment, hsCRP (0.24 ± 0.22) for control and ( 0.76 ± 1.01) for treatment, ESR (25.56 ± 23.44) for control and (26.00 ± 25.27) for treatment. There was a significant decrease in MEX SLEDAI score in the treatment group. There was no significant reduction in hsCRP and ESR of SLE patients in both groups.Conclusion: This study showed that the effect of lowering the MEX SLEDAI score on the administration of Moringa leaf extract was significant and could not significantly reduce hsCRP and ESR levels.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 291-297

Evaluation of high-sensitivity C-reactive protein and uric acid in vericiguat-treated patients with heart failure with reduced ejection fraction.

AimsThe effects of vericiguat vs. placebo on high‐sensitivity C‐reactive protein (hsCRP) and serum uric acid (SUA) were assessed in patients with heart failure with reduced ejection fraction (HFrEF) in the Phase 2 SOCRATES‐REDUCED study (NCT01951625).Methods and resultsChanges from baseline hsCRP and SUA values at 12 weeks with placebo and vericiguat (1.25 mg, 2.5 mg, 5.0 mg and 10.0 mg, respectively) were assessed. The probability of achieving an hsCRP value of ≤3.0 mg/L or SUA value of <7.0 mg/dL at week 12 was tested. Median baseline hsCRP and SUA levels were 3.68 mg/L [interquartile range (IQR) 1.41–8.41; n = 335] and 7.80 mg/dL (IQR 6.40–9.33; n = 348), respectively. Baseline‐adjusted mean percentage changes in hsCRP were 0.2%, −19.5%, −24.3%, −25.7% and −31.9% in the placebo and vericiguat 1.25 mg, 2.5 mg, 5.0 mg and 10.0 mg groups, respectively; significance vs. placebo was observed in the vericiguat 10.0 mg group (P = 0.035). Baseline‐adjusted mean percentage changes in SUA were 5.0%, −1.3%, −1.1%, −3.5% and −5.3% in the placebo, and vericiguat 1.25 mg, 2.5 mg, 5.0 mg and 10.0 mg groups, respectively; significance vs. placebo was observed in the 5.0 mg and 10.0 mg groups (P = 0.0202 and P = 0.004, respectively). Estimated probability for an end‐of‐treatment hsCRP value of ≤3.0 mg/L and SUA value of <7.0 mg/dL was higher with vericiguat compared with placebo. The effect was dose‐dependent, with the greatest effect observed in the 10.0 mg group.ConclusionsVericiguat treatment for 12 weeks was associated with reductions in hsCRP and SUA, and a higher likelihood of achieving an hsCRP value of ≤3.0 mg/L and SUA value of <7.0 mg/dL.

Effect of grape polyphenols on selected inflammatory mediators: A systematic review and meta-analysis randomized clinical trials.

Grapes contain different polyphenols and might prevent inflammation by reducing Nitric Oxide (NO) inactivation through antioxidative enzymes. The aim of this article was to demonstrate the effects of grape polyphenols on the selected inflammatory mediators, such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a), and high-sensitivity C-reactive protein (hs-CRP). To find papers assessing the effects of grape polyphenols on inflammatory mediators, electronic data bases, including ISI web of science, PubMed/Medline, SCOPUS, and Google scholar, were searched up to March 2019. Delphi checklist was used for evaluating the qualities of the included articles. The protocol was registered in PROSPERO (No. CRD42019116695). The mean changes in the intervention and control groups were calculated by subtracting the end values from the baselines. Then, the difference between the two changes was measured and utilized as the effect size in meta-analysis. 9 and 8 articles were included in the systematic review and meta-analysis, respectively. Our results indicated that grape polyphenols did not reduce hs-CRP levels, but omission of one article could lead to a significant reduction in hs-CRP (Weight Mean Difference (WMD): −0.54 mg/L, 95 % CI: −1.02, -0.06; P=0.026, I2=0.0 %). Regarding IL-6 and TNF-α, no significant changes were observed in the intervention compared to the control group (WMD: 0.04 pg/mL, 95 % CI: −0.02, 0.28; P=0.744, I2=0.0 %, WMD: -0.10 pg/mL, 95 % CI: −0.25, 0.05; P=0.183, I2=0.0 %, respectively). We found no beneficial effects of grape polyphenols on the selected inflammatory mediators. Still, more studies with higher doses of polyphenols, longer treatment durations, different sources of grape polyphenols, and larger numbers of participants are required.

Correlation Between Oral Health and Systemic Inflammation (COHESION): A Randomized Pilot Follow-Up Trial of a Plaque-Identifying Toothpaste

BackgroundInflammation is intimately involved in the pathogenesis of atherosclerosis and is accurately measured by high-sensitivity C-reactive protein (hs-CRP), a sensitive marker for future risk of cardiovascular disease. The Correlation between Oral Health and Systemic Inflammation (COHESION) trial was designed to test the hypothesis that PlaqueHD, a plaque-identifying toothpaste, reduces hs-CRP. MethodsThe trial was designed initially to include 132 subjects with hs-CRP between 2.0 and 10.0 mg/L but instead randomized 112 between 0.5 and 10.0, of which 103 had baseline and follow-up data and comprised the intention-to-treat sample. Of these, a prespecified subgroup analysis included 40 with baseline hs-CRP >2.0 and all hs-CRP <10. Because the distribution of hs-CRP was skewed toward higher values, to achieve normality assumptions, the significance of changes in hs-CRP between groups over time was tested on log-transformed data using a mixed effects analysis of variance. ResultsThe intention-to-treat analysis showed no significant differences between the PlaqueHD and placebo group (P = .615). The prespecified subgroup analysis showed a significant difference between the PlaqueHD and placebo group (P = .047). Results of the analysis showed a reduction in hs-CRP at follow-up of 0.58 in the PlaqueHD and an increase of 0.55 in the placebo group. ConclusionsThese findings are compatible with those of a prior pilot trial that also suggested benefits only in subjects with baseline elevations. Future trials targeting reductions of hs-CRP levels should randomize subjects with baseline hs-CRP between 2.0 and 10.0 mg/L.

Relationship between inflammatory factors and arrhythmia and heart rate variability in OSAS patients.

Obstructive Sleep Apnea Syndrome (OSAS) is a disorder characterized by recurrent upper airway obstruction, apnea, and hypopnea, associated with decreased oxygen saturation and disturbed sleep structure during sleep. It was found that OSAS was associated with a variety of arrhythmia and conduction disorders, but the relationship between multiple types of arrhythmia and the severity of OSAS, and its possible mechanism remain unclear. The purpose of this study was to observe the main types of arrhythmia and the condition of heart rate variability (HRV) in patients with OSAS, to detect the levels of multiple inflammatory factors in serum of OSAS patients, and to observe the correlation between polysomnographic parameters or inflammatory factors, and arrhythmia or HRV, as well as its possible mechanisms. 141 patients with suspected OSAS were collected in the Second Affiliated Hospital of Soochow University and Xinghua People's Hospital from February 2016 to February 2018. According to the sleep apnea hypopnea index (AHI), they were divided into control group (AHI <5, n = 34), mild-moderate OSAS group (5≤ AHI <30, n = 48), and severe OSAS group (AHI ≥30, n = 59). Clinical data such as gender and age were collected. All patients completed polysomnography (PSG), 24-hour Holter monitoring and blood routine, biochemical indexes and serum hs-CRP, TNF-α, IL-6, and IL-1β testing. The indicators in the three groups were compared, and the correlation between PSG parameters, HRV and inflammatory biomarkers was investigated. Compared with control group, there were significant differences in age, sex ratio, BMI, uric acid, TC, and TG in the mild-moderate OSAS group (p<0.05), and in age, sex ratio, BMI, red blood cell count, hemoglobin, hematocrit, uric acid, FBS, TC, TG, LDL, and HDL in severe OSAS group (p<0.05). There were significant differences in gender ratio, BMI, red blood cell count, hemoglobin, hematocrit, uric acid, FBS, TC, TG, LDL, and HDL between mild-moderate OSAS group and severe OSAS group (p<0.05). Heart rate variability (HRV) parameters include SDNN, SDNN index, RMSSD, PNN50, LF, HF, and LF/HF. SDNN, PNN50, and HF in severe OSAS group and mild-moderate OSAS group were significantly lower than those in control group (p<0.05). LF/HF was significantly higher than that of control group (p<0.05). There was a significant difference in PNN50, HF, and LF/HF between severe OSAS group and mild-moderate OSAS group (p<0.05). In terms of inflammation, serum hs-CRP was significantly higher in mild-moderate OSAS group and severe OSAS group than that in control group (p<0.05). Serum IL-1β was significantly higher in mild-moderate OSAS group than that in severe OSAS group (p<0.05). There was no significant difference in other indicators (p>0.05). There was a significant positive correlation between hs-CRP and oxygen reduction index (ODI) (r=0.209, p=0.013) and a significant negative correlation with PNN50 (r=-0.188, p=0.025). There is no significant correlation between other indicators. Systemic inflammatory reactions existed in patients with OSAS. With the increase of OSAS, inflammation was aggravated, especially serum hs-CRP. Hs-CRP was significantly and negatively correlated with PNN50 and positively correlated with ODI. The results suggested that the inflammatory response was involved in the occurrence of heart rate variability in OSAS patients.

Effects of cinnamon supplementation on expression of systemic inflammation factors, NF-kB and Sirtuin-1 (SIRT1) in type 2 diabetes: a randomized, double blind, and controlled clinical trial

Background and objectivesNF-kB, SIRT1 and systemic inflammation factors including hs-CRP, IL-6 and TNF-α accelerate atherosclerosis pathogenesis. Our purpose was to evaluate the effect of daily supplementation of three-gram cinnamon on plasma levels of NF-kB, SIRT, hs-CRP, IL-6 and TNF-α among type 2 diabetes patients.Subjects and methodsA randomized, double blind, and controlled clinical trial was performed with 44 adult patients who were 25 to 70 years old with type 2 diabetes, randomized to two intervention (n = 22) and control (n = 22) groups differing by daily three grams cinnamon supplementation and placebo for 8 weeks, respectively. The plasma levels of NF-kB, SIRT, hs-CRP, IL-6 and TNF-α were measured by ELISA assay at the beginning and end of the study.ResultsAfter 8-week intervention, 39 subjects (n = 20 in the cinnamon and n = 19 in the placebo groups) ended up the trial. It was not observed significant difference in levels of hs-CRP (P = 0.29), TNF-α (P = 0.27), IL-6 (P = 0.52), and Sirtuin-1 (P = 0.51) in between group comparison. While, the result showed significant difference in levels of NF-kB (P = 0.02) between groups. As well as, in among group comparison, there was not observed significant differences except in hs-CRP (P = 0.008) in placebo group.ConclusionsThis study elucidated that cinnamon supplementation has no beneficial effects in reduction of NF-kB, SIRT1, hs-CRP, IL-6 and TNF-α levels in type 2 diabetes patients which have a considerable role in development of atherogenesis.

Randomized Controlled Trial of Herbal Extracts (Eugenia polyantha, Apium graveolens, Nigella sativa) and Allopurinol Effect on Serum Uric Acid, Urinary Uric Acid and High Sensitivity C-Reactive Protein Levels in Subject with Hyperuricemia

Background: Eugenia polyantha, Apium graveolens, and Nigella sativa are extracts which in preclinical trial can reduce uric acid serum, increase urinary uric acid excretion. Allopurinol is an inhibitor of the xanthine oxidase enzyme which can also reduce the increase of hsCRP in subjetcs with hyperuricemia.&#x0D; &#x0D; Objective: To determine the safety and effect of herbal extracts in reducing serum uric acid, increasing uric acid excretion and reducing hsCRP levels in patients with hyperuricemia compared with allopurinol.&#x0D; &#x0D; Method: This study was a double blind randomized controlled trial (RCT). The subjects were hyperuricemic patients aged ³18 years. The subject was divided into groups that received 3000 mg/day of herbal extracts and allopurinol 100 mg/day for 4 weeks. Evaluation of serum uric acid and urinary uric acid urine were every week, and hsCRP levels was baseline and end of intervention. Other parameters related to the safety of use were examined every 2 weeks.&#x0D; &#x0D; Results: A number of 44 hyperucemia subjects, 23 subjects received herbal extracts and 21 subjects received allopurinol. The decrease of uric acid serum levels in the herbal extract group was 0,467±1,123;0,600;-2,70-3,00 (p=0.027), while in the allopurinol group 1,11&#x0D; 4±0,813;1,30;-1,30-2,30 (p=0,000). Uric acid excretion in the herbal extract group decrease 71,00±1,970;5,50;-92,00-702,00 (p=0,269) and in the allopurinol group decrease 64,54±1,298;22,00;-29,00-440,0 (p=0.003). The reduction of hsCRP in the herbal extract group was 0.08±0.639; 0.01; -1.55-2.05 (p=0.658), and the allopurinol group was -0.33 ± 0.806; -0.01; -2.73- 0.31 (p=0.256).&#x0D; &#x0D; Conclusion: Herbal extracts (Eugenia poliantha, Apium graveolens and Nigella sativa) and allopurinol can reduce serum uric acid levels in patients with hyperuricemia. Allopurinol also can reduce urinary uric acid excretion.

A study of effect of low dose atorvastatin therapy on high sensitivity C-reactive protein in patients with modifiable and non-modifiable cardiovascular risk factors in central India

Background: Anti-inflammatory effects of statins have generated maximum interest, as has been demonstrated in a number of studies showing rapid decrease in CRP levels in patients of acute coronary syndromes. This CRP lowering property of statins has also translated into clinical benefits as suggested by reduction in rate of recurrent angina, recurrent myocardial infarction, and mortality.Methods: This prospective, open, and controlled study was conducted on 160 indoor and outdoor patients, for total duration of two years (2005-2006), in GMC Bhopal, MP, India.Results: In all the four groups, baseline serum hs-CRP was statistically significant (p value &lt;0.01) higher than normal hs-CRP level. Mean reduction (%) in hs-CRP after 3 months of statin therapy was 83.6% in group A and 62.4% in group C which is highly significant (p value &lt;0.001). In group B also, 26% hs-CRP reduction was noticed which is statistically significant (p value &lt;0.01). Baseline hs-CRP was statistically significant high (p value &lt;0.01) in hypertensive patients. Percentages reduction in group A (87%) and group C (66%) was statistically significant (p value &lt;0.01). Baseline hs-CRP was statistically significant higher (p value &lt;0.01) than normal population. After 3 months of statin therapy percentage reduction in group A and group C was statistically significant (p value &lt;0.01). Conclusions: Low dose atorvastatin can significantly reduce CRP level in patients with risk factors for cardiovascular disease. Early initiation of low dose atorvastatin can reduce this inflammatory marker in both ACS and high risk for ACS patients and can prevent major adverse cardiac events.

P3471Anti-inflammatory effects of direct oral anticoagulants in patients with non-valvular atrial fibrillation: insights from 2216 patients in the DIRECT registry

Abstract Background Several previous studies reported anti-inflammatory effect of direct oral anticoagulant (DOAC). However, it was limited to basic pathological data with small sample size. Real-world large clinical data is still scarce. Methods We conducted a single-center prospective observational registry of NVAF patients treated with DOACs: the DIRECT registry (UMINehz745.034333283). All patients with nonvalvular atrial fibrillation (NVAF) (N=2216) who were users of dabigatran (N=648), rivaroxaban (N=538), apixaban (N=599), or edoxaban (N=431) from June 2011 to November 2017 were enrolled (71.6±10.8 years, 36.4% female, follow-up duration: 407.2±388.3 days). High sensitive C-reactive protein (hsCRP) test was performed before (within 3 months from the start) and after the start of DOAC prescription (6±3 months after the start). Patients with a hsCRP value &gt;1.00 mg/dL were excluded from the analysis due to possibility of other systemic inflammatory conditions. The present post-hoc study of the DIRECT registry assessed anti-inflammatory effect of DOAC. Pre-hsCRP and post-hsCRP were compared by Wilcoxon Signed Ranks test. Results A total of 1,855 patients were analyzed in the present study (71.0±10.7 years, 677/1,855 (36%) females). In the overall cohort, hsCRP significantly decreased after the start of DOAC prescription (pre median 0.08 interquartile range [0.04–0.17] mg/dL vs. post 0.06 [0.03–0.12] mg/dL, p&lt;0.001). The significant reduction of hsCRP was consistent across all DOACs (p=0.301) [dabigatran (N=562), pre 0.08 [0.04–0.1625] mg/dL vs. post 0.06 [0.03–0.12] mg/dL, p&lt;0.001: rivaroxaban (N=457), pre 0.07 [0.04–0.16] mg/dL vs. post 0.07 [0.03–0.125] mg/dL, p&lt;0.001: apixaban (N=494), pre 0.09 [0.04–0.19] mg/dL vs. post 0.06 [0.03–0.13] mg/dL, p&lt;0.001: edoxaban (N=342), pre 0.08 [0.04–0.19] mg/dL vs. post 0.06 [0.03–0.13] mg/dL, p&lt;0.001]. Conclusions The present study of DIRECT registry suggested anti-inflammatory effect of DOAC presented as a significant reduction of hsCRP. Although further investigation would be warranted to evaluate the clinical significance of the suppressed systemic inflammation, the recent favorable clinical data of DOACs might be attributed to the present finding.

Effect of Whey Protein Supplementation on Inflammatory and Antioxidant Markers, and Clinical Prognosis in Acute Ischemic Stroke (TNS Trial): A Randomized, Double Blind, Controlled, Clinical Trial.

Purpose: Malnutrition is extensively prevalent amongst critically ill patients afflicted by ischemic stroke (IS). This study purpose was to evaluate the protein whey effect on inflammatory and antioxidant markers and functional prognosis in acute IS patients. Methods: out of 42 patients with acute IS who were referred to Imam Reza Educational Hospital, Tabriz, Iran, 40 patients participated in the study. Twenty-one patients as control group received the hospital routine formula, and 19 patients as intervention group received 20 g/daily of whey protein through oral gavage. Inflammation and oxidative stress indicators (e.g., albumin, malondialdehyde (MDA), total antioxidant capacity (TAC), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and high sensitivity C reactive protein (hs-CRP)and clinical variables included in were evaluated using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during admission and also 3 weeks after intervention. Results: Whey protein supplementation significantly decreased the NIHSS and mRS scores, TNF-α, IL-6, and hs-CRP by passing 3 weeks from intervention (P<0.05). However, whey formula had no significant effect on other markers including albumin, and MDA. The hs-CRP (P = 0.02) reduction was significantly higher in whey protein group in comparison with control group. Conclusion: Whey protein supplementation reduced inflammation markers in those patients with IS. However, these changes should be studied in larger-scale trials.

Effect of pomegranate fruit supplementation on performance and various markers in athletes and active subjects: A systematic review.

The aim of the study was to review recent findings on the use of POM supplements in athletes of various disciplines and physically active participants. Eleven articles published between 2010 and 2018 were included, where the total number of investigated subjects was 176. Male participants constituted the majority of the group (n=155), as compared to females (n=21). 45% of research described was conducted on athletes, whereas the remaining studies were based on highly active participants. Randomised, crossover, double-blind study designs constituted the majority of the experimental designs used. POM supplementation varied in terms of form (pills/juice), dosage (50ml-500ml) and time of intervention (7 days-2 months) between studies. Among the reviewed articles, POM supplementation had an effect on the improvement of the following: whole body strength; feeling of vitality; acute and delayed muscle fatigue and soreness; increase in vessel diameter; blood flow and serum level of TAC; reduction in the rate of increase for HR, SBP, CK and LDH; support in the recovery of post-training CK, LDH, CRP and ASAT to their baseline levels; reduction of MMP2, MMP9, hsCRP and MDA; and increased activity of antioxidant enzymes (glutathione peroxidase and superoxide dismutase). In the majority of reviewed articles POM supplementation had a positive effect on a variety of parameters studied and the authors recommended it as a supplement for athletes and physically active bodies.

Healthy diet reduces markers of cardiac injury and inflammation regardless of macronutrients: Results from the OmniHeart trial

BackgroundDespite diet being a first-line strategy for preventing cardiovascular disease, the optimal macronutrient profile remains unclear. We studied the effects of macronutrient profile on subclinical cardiovascular injury and inflammation. MethodsOmniHeart was a randomized 3-period, crossover feeding study in 164 adults with high blood pressure or hypertension (SBP 120–159 or DBP 80–99 mm Hg). Participants were fed each of 3 diets (emphasizing carbohydrate (CARB), protein (PROT), or unsaturated fat (UNSAT)) for 6-weeks, with feeding periods separated by a washout period. Weight was held constant. Fasting serum was collected at baseline while participants ate their own diets and after each feeding period. High-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity C-reactive protein (hs-CRP) were measured in stored specimens. ResultsThe average age was 53.6 years, 55% were African American, and 45% were women. At baseline, the median (25th-percentile, 75th-percentile) hs-cTnI was 3.3 ng/L (1.9, 5.6) and hs-CRP was 2.2 mg/L (1.1, 5.2). Compared to baseline, all 3 diets reduced hs-cTnI: CARB –8.6% (95%CI: −16.1, −0.4), PROT –10.8% (−18.4, −2.5), and UNSAT −9.4% (−17.4, −0.5). Hs-CRP was similarly changed by −13.9 to −17.0%. Hs-cTnI and hs-CRP reductions were of similar magnitudes as SBP and low-density lipoprotein cholesterol (LDLc) but were not associated with these risk-factor reductions (P-values = 0.09). There were no between-diet differences in hs-cTnI and hs-CRP reductions. ConclusionsHealthy diet, regardless of macronutrient emphasis, directly mitigated subclinical cardiac injury and inflammation in a population at risk for cardiovascular disease. These findings support dietary recommendations emphasizing healthy foods rather than any one macronutrient.Trial Registration: This trial is registered at clinicaltrials.gov, number: NCT00051350; URL: https://clinicaltrials.gov/ct2/show/NCT00051350.