Significant Reduction In hs-CRP Levels Research Articles

Effect of colchicine on inflammatory markers in patients with coronary artery disease: A meta-analysis of clinical trials

Whether colchicine reduces the levels of high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) remains uncertain. Therefore, this systematic review and meta-analysis were conducted to evaluate the overall effect of colchicine treatment on hs-CRP and IL-6 levels in patients with coronary artery disease (CAD). PubMed/Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies published before October 2021. Clinical trials in patients with CAD with reports of hs-CRP and IL-6 level changes before and after colchicine intervention were included. In total, 11 trials on hs-CRP and two trials on IL-6 were included in this meta-analysis. Compared with that in the control group, colchicine treatment was significantly associated with decreased hs-CRP levels (weighted mean differences [WMDs], −0.81 mg/L; 95% confidence interval [CI], −1.34 to −0.28 mg/L; P = 0.003) in patients with CAD. Besides, the levels of IL-6 were significantly reduced in colchicine users compared to that of placebo (WMD, −1.28 pg/mL; 95% CI, −2.35 to −0.21 pg/mL; P = 0.02). In a subgroup analysis, colchicine led to a significant reduction in hs-CRP levels in studies with duration of intervention >7 days (WMD, −0.65 mg/L; 95% CI, −1.08 to −0.21 mg/L; P = 0.004) and studies with baseline hs-CRP levels ≥3.0 mg/L (WMD, −0.99 mg/L; 95% CI, −1.92 to −0.06 mg/L; P = 0.04). Colchicine intervention was associated with a reduction in hs-CRP and IL-6 levels in patients with CAD. Future investigations are required to verify the effect of colchicine on inflammatory markers and clarify the potential mechanisms of the cross talk between colchicine, inflammation, and cardiovascular outcomes.

Oral Health Education Combined with Routine Dental Treatment Reduces hsCRP

A multitude of studies investigated the beneficial effects of periodontitis therapy on general health. In contrast, the present trial aimed to investigate the effect of an oral health education program combined with routine dental treatment on serum biomarkers of systemic health in a community of low-socioeconomic background with general dental treatment needs. Eligible participants (plaque index >50%, bleeding on probing >30%, active carious lesion) were randomised to a group that received dental treatment combined with an oral health education program (OHE+GDT) or a group that received general dental treatment only (GDT). Participants in both groups received routine dental treatment. In addition, participants in the OHE+GDT group received 180 min of health education and a full-mouth debridement. Serum levels of high-sensitivity C-reactive protein (hsCRP), lipid profiles, and HbA1c were measured at baseline and after 12 months. 295 participants (mean age, 45.4 ± 11 years) were analysed. Periodontal health significantly improved in both groups. However, no intergroup differences were detected (P=0.92 Generalised Estimating Equation (GEE)). A significant reduction of hsCRP levels at the follow-up assessment was observed in the OHE+GDT group, which was significantly different from the GDT group (P =0.01). Multivariate modelling indicated that baseline hsCRP levels, baseline body mass index, and higher consumption of vegetables (P = 0.021) predicted a reduction in hsCRP levels. This study demonstrated that oral health education combined with routine dental treatment was associated with a significant reduction in hsCRP levels and hence suggests a beneficial effect on general health.

Effect of oral vitamin C on serum hepcidin level, iron status and inflammation among hemodialysis patients with functional iron deficiency anaemia

Introduction: Hepcidin is a key regulatory peptide in iron homeostasis, the pathogenesis of functional iron deficiency (FID) anemia and erythropoiesis-stimulating agent (ESA) resistance is contributed to the inflammatory mediated increase in the serum hepcidin levels among prevalent hemodialysis (HD) patients. Objectives: To test the reducing therapeutic effect of oral vitamin C supplements on hepcidin levels and iron status among HD patients with FID anemia. Patients and Methods: This study is an interventional prospective cohort study; 48 prevalent HD patients were enrolled. Group one: 31 patients who received the conventional treatment of erythropoietin stimulating agents together with oral supplementation of vitamin C 500 mg every other day dose for 3 months. Group two: 17 patients who received only the conventional therapy of erythropoietin stimulating agents. Patients with hemoglobin level <11 g/dL, ferritin level >200 ng/mL and transferrin saturation (TSAT) >20 % were included. Laboratory parameters: serum hepcidin, high-sensitivity C-reactive protein (hs-CRP) titre, CBC, and iron indices were measured at baseline and after 3 months. Results: On comparing the two groups, oral vitamin C in group 1 resulted in a statistically significant reduction in hepcidin levels [mean 2506.456 ± 1320.53 pg/mL to 1748.396 ± 1432.28 pg/mL (P = 0.03)], and a significant reduction in hs-CRP level [mean 8603.236 ± 2547.77 ng/mL to 5611.296 ± 2829.27 ng/mL] (P = 0.001) after three months of treatment in comparison to control group. A decrease of EPO requirement and elevation of hemoglobin level were observed in a study group with oral vitamin C. Conclusion: Oral vitamin C may be a promising therapy in decreasing serum hepcidin and inflammatory markers among prevalent HD patients with FID anemia.

P1375ORAL VITAMIN C EFFECT ON HEPCIDIN LEVEL IN HAEMODIALYSIS PATIENTS WITH FUNCTIONAL IRON DEFICIENCY ANAEMIA

Abstract Background and Aims Hepcidin is a key regulatory peptide in iron homeostasis, inhibiting iron absorption by binding to ferroportin. Inflammatory mediated increase in hepcidin levels and reduced clearance in hemodialysis (HD) patients lead to functional iron deficiency ( FID) and Erythropoiesis-stimulating agent (ESA) resistance. Ascorbic acid (Vitamin C) may be used as adjuvant therapy in FID anemia through its anti-inflammatory and anti-oxidant nature, but there was limited studies investigating the direct relation between vitamin C and hepcidin level in HD patients. We Aimed to test the reducing therapeutic effect of oral vitamin C supplement on hepcidin level among hemodialysis patients with functional iron deficiency anaemia. Method This study is an open label randomized controlled clinical trial that was conducted in hemodialysis units of Ain Shams University hospitals, 48 prevalent HD patients with mean age of 46.48 ± 15.57 years were included ,Group 1 (study group) :31 patients [13(41.9%) males & 18(58.1%) females] who received the conventional treatment of erythropoietin stimulating agents together with oral supplementation of vitamin C 500 mg every other day dose for 3 months. Group 2 (control group): included 17 patients [8(47.1%) males and 9 (52.9%) females] who received only the conventional therapy of erythropoietin stimulating agents according to their Hb levels. The patients enrolled in the study were patients on regular conventional HD for more than 6 months with functional iron deficiency anemia, defined as: hemoglobin level <11 gm/dl, ferritin level >200 ng/ml and TSAT >20 %. Patients with history of non-renal causes of anemia including malignancy, end-stage liver disease, or chronic hypoxia, patients with evidence of active or occult bleeding, patients who received blood transfusion within the last 4 months, history of recent hospitalization or infection requiring antibiotics within the last 4 weeks and patients with evidenced iron deficiency anemia were all excluded from the study .Laboratory parameters including serum hepcidin level, highly sensitive CRP (hsCRP) titer, CBC, kidney function tests and iron indices were measured at baseline and after 3 months . Results Oral vitamin C supplementation in Group 1(study group) resulted in statistically significant reduction in Hepcidin levels in the study group [mean 2506.45± 1320.53 pg/ml to 1748.39 ±1432.28 pg/ml ](P=0.03), and highly significant reduction in hsCRP level [mean 8603.23 ±2547.77 ng/ml to 5611.29 ±2829.27 ng/ml](P=0.001) after 3months of treatment. On comparing the two groups regarding changes in Hepcidin levels during follow up, illustrates that vitamin C together with time resulted in significant reduction of hepcidin levels in the study group (P<0.05) by repeated measure ANOVA test (Figure 1). Comparison between the two groups regarding change in hsCRP levels during follow up showed there was a highly significant change in the mean hsCRP over time, and the mean hsCRP differed significantly between the two groups (Figure 2). A significant reduction in serum iron and ferritin levels was observed in study group after treatment vitamin C but the change of the mean of S. ferritin level didn’t differ significantly in comparison to control group . Decreased EPO requirements and elevation of hemoglobin level were observed in the study group but without a statistical significance compared to the control group, this might be attributed to the short period of vit C supplementation. There was a highly significant correlation between serum hepcidin and hsCRP (r=0.46, P<0.01) . Conclusion : Oral Vitamin C may be promising therapy in decreasing serum hepcidin and hsCRP in prevalent hemodialysis patients with functional iron deficiency anemia.

Differences in the response to iron supplementation on oxidative stress, inflammation, and hematological parameters in nonanemic and anemic pregnant women

Background Iron supplementation is widely recommended for all pregnant women, irrespective of their iron status. But providing excess iron to nonanemic pregnant women can result in iron overload, which may lead to oxidative stress and inflammation. Objectives To assess the differential effect of iron supplementation on hematological parameters, oxidative stress, and inflammation in nonanemic and anemic pregnant women. Methods Forty nonanemic and forty anemic pregnant women were recruited at 12 weeks of gestation. The study subjects were supplemented with iron (60 mg/day for nonanemic pregnant women and 120 mg/day for anemic pregnant women). Fasting state blood samples were collected at 12 and 28 weeks of gestation. Results Malondialdehyde (MDA)/total antioxidant status (TAS) ratio (MDA/TAS) and high-sensitivity C-reactive protein (hsCRP) were significantly higher in anemic pregnant women before iron supplementation. Iron supplementation to the anemic pregnant women resulted in significant improvement in the hematological profile and ferritin levels. Further, the iron supplementation caused a significant reduction in hsCRP levels although the MDA/TAS ratio remained unaltered. Iron supplementation to nonanemic pregnant women resulted in a significant increase in the levels of MDA/TAS ratio and hsCRP, but there were no changes in hematological profile and serum ferritin levels. Conclusion Prophylactic iron supplementation in nonanemic pregnant women increased oxidative stress and inflammation. However, in anemic pregnant women, iron supplementation was found to be beneficial as it improved hematological status and decreased inflammation without affecting oxidative stress.

Evaluation of Curcumin's effect on inflammation in hemodialysis patients

Despite advances in prevention of inflammatory milieu with different anti-inflammatory modalities in hemodialysis patients the rate of inflammatory markers in this population are still high. Inflammation is considered as a major player in uremia associated with morbidity and mortality in hemodialysis patients. The aim of this study was to evaluate the turmeric s effects on reduction of inflammatory markers in hemodialysis patients. Hemodialysis patients over 18 years were recruited after fulfilling the inclusion criteria. Seventy-one hemodialysis patients were randomized into two groups: the trial group (n=35) and the controls (n=36); a randomization numeric table was used for allocation sequence. Trial group received turmeric and control group received placebo for 12 weeks. Biochemical determinations included levels of serum albumin (Alb), potassium (K), blood urea nitrogen (BUN), serum creatinine (Cr), IL-6 level, TNF-α, and liver function tests and hs-CRP at the start and end of the study were measured. Although there was a significant reduction in hs-CRP level, IL-6 level and TNF-α level in turmeric group (p=0.002, p=0.001, p=0.001), there was no statistical difference between intervention and control groups. Albumin level was significantly increased in turmeric group (p=0.001) and no meaningful changes were seen in potassium or liver function tests neither within nor between groups. Programmed ingestion of turmeric has no adverse effects and reduces plasma level of hs-CRP, IL-6 and TNF-α accompanying with increases albumin levels in hemodialysis patients. Turmeric can be considered as an effective anti-inflammatory supplement in hemodialysis patients.

Study of High Sensitive C-Reactive Protein (HS-CRP) After Cardiac Rehabilitation Program in Patients Undergoing Isolated CABG

Introduction: Although cardiac rehabilitation is known as a tool to reduce the overall risk of cardiovascular complications, its specific role in the reduction of hs-CRP as a marker of inflammation and a proven marker of cardiovascular risk needs further investigation. Aim: The present study aims at elucidating the effects of a full course of conventional cardiac rehabilitation program for the period of eight weeks, on the levels of hs-CRP in patients who underwent isolated coronary artery bypass surgery. Material and Methods: In this case study, 30 consecutive patients who underwent isolated coronary artery bypass surgery (isolated CABGS), and a full 8-week cardiac rehabilitation program in Tehran Heart Center, were investigated. A group of 30 similar patients, who enrolled in the same period of rehabilitation program but did not participate in practice, was considered as a control group. Serum levels of hs-CRP in both groups were measured retrospectively and in similar days before the start of rehabilitation program and at the end of it (or 8 weeks after initial registration for the control group). Results: Levels of hs-CRP in the rehabilitation group and control group were 5.9 7.7 and 6.3 6.9 respectively before start of the program which was not statistically meaningful (P-Value = 0.833). However, after the program, level of hs-CRP in the two tested groups changed to 2.3 5.1 and 5.7 6.1 respectively which showed a meaningful correlation (P-Value = 0.023). These results also showed that decrease in hs-CRP level in the rehabilitated group but not in the control group was statistically meaningful (with P-Value of 0.037 and 0.0723 respectively). Conclusion: In patients undergoing coronary bypass surgery, participating in a full course of cardiac rehabilitation for 8 weeks has resulted in a significant reduction in hs-CRP levels as a marker of cardiovascular risk.

The randomized clinical trial of coenzyme Q10 for the prevention of periprocedural myocardial injury following elective percutaneous coronary intervention

Periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI) is an important therapeutic concern with remaining some mortality and morbidity. To the best of our knowledge, there is no published study that investigates the potential benefit of CoQ10 in preventing PMI following elective PCI. In a randomized, clinical trial, 100 patients who scheduled for elective PCI were allocated in to the intervention (n=50) and control group (n=50). The intervention received a 300mg loading dose CoQ10 12hours before procedure. The level of CK-MB and troponin-I was measured before procedure, and 8 and 24hours after. Furthermore, hs-CRP was measured at baseline and 24hours after. All patients were assessed for the incidence of major adverse cardiac effects (MACEs) after 1month. The CK-MB elevation (above the upper limit normal) was occurred in 22% (n=11) of CoQ10 and 20% (n=10) of control (P=.806). The elevation of troponin-I was documented in 8% (n=4) of both groups. No significant change in the level of cardiac biomarkers was noted. However, the significant reduction in hs-CRP level was occurred in CoQ10 group (P=.032). The results showed that pretreatment with 300mg CoQ10 12hours before procedure could not reduce PMI following elective PCI, however, significantly decreased hs-CRP.

Prasugrel Results in Higher Decrease in High-Sensitivity C-Reactive Protein Level in Patients Undergoing Percutaneous Coronary Intervention Comparing to Clopidogrel.

OBJECTIVESA growing body of clinical and laboratory evidence indicates that inflammation plays a crucial role in atherosclerosis. In the present study, we compared the effects of clopidogrel and prasugrel on high-sensitivity C-reactive protein (hs-CRP) in patients undergoing percutaneous coronary intervention (PCI).METHODSThe present randomized, double-blind clinical trial included 120 patients who underwent PCI. Eligible patients were randomly assigned 2:1 to one of the two groups: 80 patients in the first group received clopidogrel (Plavix®; loading dose and maintenance dose of 300 and 75 mg daily, respectively) and 40 patients in the second group received prasugrel (Effient®; loading dose and maintenance dose of 60 and 10 mg, respectively) for 12 weeks. The hs-CRP levels between baseline and 12th week were compared.RESULTSOf the 120 patients, 69 patients (57.5%) were male. Pretreatment hs-CRP level was statistically comparable in clopidogrel (median, 15.10 mg/dL; interquartile range [IQR], 9.62–23.75 mg/dL) and prasugrel groups (median, 18 mg/dL; IQR, 14.25–22 mg/dL; P = 0.06). Patients taking clopidogrel showed a significant reduction in hs-CRP level compared with the baseline values (P < 0.001). Prasugrel administration also resulted in a significant reduction in hs-CRP level (P < 0.001). A significant 73% overall reduction in the hs-CRP level was seen with prasugrel compared with 39% overall reduction in hs-CRP level with clopidogrel (P = 0.002).CONCLUSIONPrasugrel seems to be superior to clopidogrel in the reduction of hs-CRP in patients undergoing PCI.

Effects of Silybum marianum (L.) Gaertn. (silymarin) extract supplementation on antioxidant status and hs-CRP in patients with type 2 diabetes mellitus: A randomized, triple-blind, placebo-controlled clinical trial

Aim: Diabetes is a serious metabolic disorder and oxidative stress and inflammation contribute to its pathogenesis and complications. Since Silybum marianum (L.) Gaertn. (silymarin) extract is an antioxidant with anti-inflammatory properties, this randomized clinical trial was conducted to evaluate the effects of silymarin supplementation on oxidative stress indices and hs-CRP in type 2 diabetes mellitus patients.Methods: For the present paralleled, randomized, triple-blinded, placebo-controlled clinical trial, 40 type 2 diabetes patients aged 25–50 yr old and on stable medication were recruited from the Iranian Diabetes Society and endocrinology clinics in East Azarbayjan (Tabriz, Iran) and randomly assigned into two groups. Patients in the silymarin treatment group received 140 mg, thrice daily of dried extracts of Silybum marianum (n = 20) and those in the placebo group (n = 20) received identical placebos for 45 days. Data pertaining to height, weight, waist circumference and BMI, as well as food consumption, were collected at base line and at the conclusion of the study. Fasting blood samples were obtained and antioxidant indices and hs-CRP were assessed at baseline, as well as at the end of the trial.Results: All 40 patients completed the study and did not report any adverse effects or symptoms with the silymarin supplementation. Silymarin supplementation significantly increased superoxide dismutase (SOD), glutathione peroxidase (GPX) activity and total antioxidant capacity (TAC) compared to patients taking the placebo, by 12.85%, 30.32% and 8.43%, respectively (p < 0.05). There was a significant reduction in hs-CRP levels by 26.83% (p < 0.05) in the silymarin group compared to the placebo group. Malondialdehyde (MDA) concentration significantly decreased by 12.01% (p < 0.05) in the silymarin group compared to the baseline.Conclusions: Silymarin supplementation improves some antioxidant indices (SOD, GPX and TAC) and decrease hs-CRP levels in T2DM patients.

Effect of Phase 2 Cardiac Rehabilitation Program on High Sensitivity C-Reactive Protein Levels in Post-Percutaneous Coronary Intervention Patients

Effect of Phase 2 Cardiac Rehabilitation Program on High Sensitivity C-Reactive Protein Levels in Post-Percutaneous Coronary Intervention Patients Objective: To assess the effects of phase 2 cardiac rehabilitation program on hs-CRP levels in patients revascularized by percutaneous coronary intervention (PCI). Methods: This study included 80 patients with a history of acute myocardial infarction or acute coronary syndrome for which total coronary revascularization had been performed by PCI. Patients were randomized into 2 equal groups; one enrolled in a cardiac rehabilitation program while the other was not. Risk factors and body mass index were assessed. Hs-CRP was measured at baseline then at the end of cardiac rehabilitation program or after three months for controls. Results: There was no significant difference between study and control patients regarding baseline characteristics. At baseline, median hs-CRP was higher in the study group 2.36 (0.63-10.6) vs 1.68 (0.57-10.1) mg/L (p=0.012). For the study group, BMI dropped from 29.6 ± 4.5 to 28.9 ± 4.3 kg/m2 (p=0.002) and the number of active smokers was reduced (p<0.0001). Hs-CRP was reduced from 2.36 (0.63-10.6) to 1.63 (0.57-7.91) mg/L (p=0.0006). Significant reductions in hs-CRP levels were found in non-smokers (p=0.018), non-hypertensive (p<0.0001) and non-diabetic patients (p<0.0001). For the control group, there was no change in BMI at 3 months (p=0.422) nor hs-CRP (p=0.145). Comparing study and control groups at follow up, revealed a lower hs-CRP in the study group 1.63 (0.57-7.19) vs 2.4 (0.8-7.85) mg/L (p=0.003). Conclusion: Participation in phase 2 cardiac rehabilitation program leads to a significant reduction in hs-CRP levels in patients with ischemic heart disease totally revascularized by PCI. Number of active smokers and BMI are also reduced.

Effects of high versus low-dose atorvastatin on high sensitive C-reactive protein in acute coronary syndrome.

Background:Cardiovascular disease is the leading cause of mortality. The previous findings which suggest the reduction in C-reactive protein (CRP) levels by statin encouraged us to conduct the present study in which we tested the effects of atorvastatin, on levels of hs-CRP in a prospective randomised clinical trial study on patients with acute coronary syndrome.Materials and Methods:Present prospective randomised clinical trial study conducted on 180 patients who had developed coronary artery disease and presented in emergency departments of Educational-Medical centers of Tabriz University of Medical Sciences. The patients were divided randomly into two groups and then two therapeutic protocols were given to them. One group medicated by high-dose atorvastatin (40 mg) and the other group received low-dose atorvastatin (20 mg). All variables were collected by questionnaires and were analyzed.Results:There were 180 patients consisted of 34 females and 56 males in low-dose atorvastatin group (L-DA group), and 30 females and 60 males in high-dose atorvastatin group (H-DA group) (P = 0.533). In this study atorvastatin in high doses decreased hs-CRP levels about 40% and in low doses it only caused decrease of 13.3%, and significant correlation was observed between two groups (Paired Sample T-test) (P = 0.001). Also atorvastatin in high doses decreased LDL levels about 23% and in low doses it only decreased 10%, and significant correlation was observed between two groups (Paired Sample T-test) (P = 0.001). Atorvastatin in high doses decreased HDL levels about 9% and in low doses it only decreased 6%, and again significant correlation was observed between two groups (P = 0.009).Conclusion:The present study confirms the novel observation that atorvastatin therapy results in a significant reduction in hs-CRP levels.

In Vivo Confirmation of the Role of Statins in Reducing Nitric Oxide and C-Reactive Protein Levels in Peripheral Arterial Disease

Inflammatory and other processes mediating impairment of endothelial function, where there are increased levels of C-reactive protein (CRP) and plasma nitrites, have a part to play in the early stages of peripheral arterial disease (PAD). Our objective was to analyse the effect of statins on the plasma nitrite and CRP levels in PAD. A prospective study of 30 patients with PAD Fontaine stage II, with no prior treatment with statins, determined high sensitivity (hs)-CRP and lipid profile in the patients. Plasma nitrite levels were determined by colorimetric assay based on the Griess reaction, at baseline and after 1 month of treatment with atorvastatin 40 mg day(-1). A significant reduction in plasma nitrite levels was detected after the treatment with statins (11.88+/-7.8 microM vs. 5.7+/-1.8 microM, p=0.0001). There was also a significant reduction in hs-CRP levels (13.58+/-24.00 vs. 3.93+/-3.19, p=0.02). When the patients were stratified according to claudication stage, a significant reduction in nitrite levels was obtained, both in patients with PAD Fontaine stage IIA (9.5+/-3.3 microM vs. 5.3+/-1.7 microM, p=0.0001) and in stage IIB (16.6+/-11.6 microM vs. 6.7+/-1.8 microM, p=0.032). Treatment with statins lowers plasma nitrite and CRP levels in patients with PAD. Our data support the effects of statins in vivo that have been demonstrated on the endothelium ex vivo, suggesting a beneficial effect by acting on the initial processes that trigger the disease, reducing oxidative stress (increase in the bioavailability of nitric oxide as peroxynitrite levels decrease) and curtailing the inflammatory processes which perpetuate the disease.

The alteration of serum soluble CD40 ligand levels in overt and subclinical hypothyroidism

There is controversy as to whether hypothyroidism increases cardiovascular risk. The effect of levothyroxine on the cardiovascular risk profile is also unclear. Recent studies suggest that there is evidence of inflammation and endothelial dysfunction in hypothyroidism. Soluble CD40 ligand (sCD40L) is a protein expressed mainly by activated platelets which have been found to be associated with cardiovascular events. The aim of our study was to investigate serum sCD40L levels and the effect of levothyroxine replacement on sCD40L levels in overt and subclinical hypothyroidism. We assessed lipid profile, serum sCD40L and hsCRP levels in 21 overt and 22 subclinical hypothyroid age-matched female patients with chronic autoimmune thyroiditis at baseline and one month after achieving euthyroidism by levothyroxine replacement, and compared them with the data from 22, age-matched, healthy controls. Overt and subclinical hypothyroid patients had decreased sCD40L levels compared to age-matched controls. The patients with subclinical hypothyroidism had slightly increased hsCRP levels, but the result was not statistically significant. In multiple regression analysis, FT3 and FT4 were found to be independent predictors of sCD40L levels. After levothyroxine replacement, serum sCD40L levels increased significantly in the patients with overt hypothyroidism. Although an increase was also observed in the subclinical hypothyroid group, it was not statistically significant. Levothyroxine replacement had no significant effect on hsCRP levels in the patients with overt hypothyroidism. However, the subjects with subclinical hypothyroidism showed a significant reduction in hsCRP levels after levothyroxine. The values of sCD40L and hsCRP in our study suggest that inflammatory pathways are complex and may be affected by different factors in hypothyroidism.

Effects of Colesevelam Hydrochloride (WelChol) on Biomarkers of Inflammation in Patients With Mild Hypercholesterolemia

Inflammation is pivotal in atherogenesis. High-sensitivity C-reactive protein (hs-CRP), the prototypic marker of inflammation, has been shown to predict cardiovascular events. Colesevelam hydrochloride (HCl) (WelChol, Sankyo Pharma Incorporated, Parsippany, New Jersey), a specifically engineered bile acid sequestrant, has been shown to be effective in lowering low-density lipoprotein (LDL) cholesterol levels in monotherapy and in combination with statins or fenofibrate. Previously, we have shown that statins lower hs-CRP levels; however, a paucity of data is available examining the effect of colesevelam HCl on hs-CRP levels. The aim of this study was to examine the effect of colesevelam HCl therapy (3.75 g/day for 6 weeks) on hs-CRP in patients with mild hypercholesterolemia in a randomized, double-blind, placebo-controlled study. Twenty-five subjects on colesevelam HCl and 23 subjects on placebo completed the study. The median baseline hs-CRP levels for the treatment and placebo groups are 3.4 and 3.1 mg/L, respectively. Colesevelam HCl therapy resulted in a significant reduction in LDL cholesterol levels (p < 0.001). No significant changes were found in total triglyceride or high-density lipoprotein cholesterol levels between the 2 groups. Furthermore, colesevelam HCl therapy resulted in a significant reduction in hs-CRP levels compared with baseline and placebo (15.9% and 18.7% median reduction, respectively, p < 0.025). No correlation was found between LDL cholesterol lowering and hs-CRP lowering (r = 0.3). In conclusion, our results show that colesevelam HCl monotherapy significantly lowered hs-CRP levels in a double-blind, placebo-controlled study.

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.