C‐Reactive Protein (CRP)‐Lowering Agents

Abstract

C-reactive protein (CRP) plays a role in the pathogenesis of cardiovascular disease. It is a marker and predictor of cardiovascular disease. CRP possesses numerous cardiovascular effects (clotting, generation of oxygen radicals, increase in the expression of adhesion molecules and plasminogen activator inhibitor-1, plaque destabilization) that could result in cardiovascular disease. This review describes the effects of various cardiovascular drugs on the levels of CRP in health and disease. Cyclooxygenase inhibitors (aspirin, rofecoxib, celecoxib), platelet aggregation inhibitors (clopidogrel, abciximab), lipid lowering agents (statins, ezetimibe, fenofibrate, niacin, diets), â-adrenoreceptor antagonists and antioxidants (vitamin E), as well as angiotensin converting enzyme (ACE) inhibitors (ramipril, captopril, fosinopril), reduce serum levels of CRP; while enalapril and trandolapril have not been shown to have the same effect. Angiotensin receptor blockers (ARBs) (valsartan, irbesartan, olmesartan, telmisartan) markedly reduce serum levels of CRP. The findings with other ARBs (losartan and candesartan) were inconsistent. Antidiabetic agents (rosiglitazone and pioglitazone) reduce CRP levels, while insulin is ineffective. Calcium channel antagonists have variable effects on CRP levels. Hydrochlorothiazide and oral estrogen do not affect CRP. The CRP-lowering effect of statins is more pronounced than their lipid lowering effect and is not dependent on their hypolipemic activity. The effect of atorvastatin on CRP seems to be dose-dependent. CRP-lowering effect of statins is likely to contribute to the favorable outcome of statin therapy. The data suggest that lipid lowering agents, ACE inhibitors, ARBs, antidiabetic agents, antiinflammatory and antiplatelet agents, vitamin E, and â-adrenoreceptor antagonists lower serum or plasma levels of CRP, while vitamin C, oral estrogen and hydrochlorothiazide do not affect CRP levels.

Different actions of losartan and ramipril on adipose tissue activity and vascular remodeling biomarkers in hypertensive patients

“…On the other hand, CRP reduction has also been observed with ramipril. 46 In this context, our results obtained in non-diabetic hypertensive subjects are in agreement with these previous observations.…”

Safety and efficacy of antihypertensive therapy with add-on angiotensin II type 1 receptor blocker after successful coronary stent implantation

“…18 In this study, olmesartan but not valsartan significantly decreased the serum level of CRP. Although there are many CRPlowering agents such as statins, b-blocker, calcium channel blockers and thiazolidine, 16 there were no significant differences in the percentage of medications between the olmesartan and valsartan groups. Although we do not know precisely why valsartan did not reduce serum CRP in this study, two possible explanations are that the dose of valsartan was relatively low and the characteristics of the participants were different from those in previous reports.…”

“…C-reactive protein plays a pathological role in the progression of CAD and is a well-established predictor of future cardiovascular events. 16 ARBs have been shown to reduce the serum or plasma CRP concentration. Olmesartan significantly reduced serum CRP in Abbreviations: eGFR, estimated glomerular filtration rate; HbA1c, hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MCP-1, monocyte chemotactic protein-1; UA, uric acid; RANTES, regulated upon activation, normal T-cell-expressed and secreted; TG, triglyceride.…”

Inflammation and exercise (INFLAME): Study rationale, design, and methods

“…Examples of these types of medications are statins, ace-inhibitors and multi-vitamins. [14][15][16] However, if the medication has been shown to reduce CRP but was used in the treatment of chronic inflammatory conditions, then the medication was cause of exclusion. Systemic steroids are an example of such a medication and the exclusion was based more on the underlying medical condition and less on the use of the medicine.…”