In this presentation Dr. Daniel Konig from Freiburg, Germany, talks about the effects of physical activity and lipid-lowering therapy on high-sensitivity C-reactive protein (hs-CRP) levels in patients with coronary heart disease.

"Inflammatory processes within the vessel wall are very important atherogenic pathomechanisms with particular relevance for the development of the vulnerable plaque," says Dr. Konig. The importance of the inflammatory biomarker hs-CRP as a prognostic indicator of vascular risk has been shown in several prospective epidemiological studies (1).

How can hs-CRP levels be lowered, and what about in patients who already have coronary heart disease? Statin therapy (2), as well as increased physical activity (3) and physical fitness (4) among other measures have been shown to be associated with lower hs-CRP values. In a cross-sectional analysis conducted by Dr. Konig's group, 436 men and women with coronary artery disease participating in outpatient exercise groups for cardiac rehabilitation were studied. Patients with the combination of high physical activity and statin therapy had significantly lower hs-CRP values than with each factor alone, suggesting an additive effect (5), however further studies are needed.

Dr. Konig also presents data on the effect of high versus low dose lipid-lowering drug therapy on the inflammatory response in these patients. The impressive effects of physical activity and increased fitness on hs-CRP should further increase our efforts to include physical activity in every cardiac prevention and rehabilitation program, concludes Dr. Konig.

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After viewing this presentation the participant will be able to discuss:

- The effects of physical activity, physical fitness and statin therapy on hs-CRP levels
- Evidence for a combined effect of physical activity and statin therapy on hs-CRP levels in patients with coronary heart disease

1. Paul M Ridker, MD. Clinical Application of C-Reactive Protein for Cardiovascular Disease Detection and Prevention Circulation. 2003;107:363.

2. P.M. Ridker. "Should statin therapy be considered for patients with elevated C-reactive protein? The need for a definitive clinical trial" Eur. Heart J., December 2001; 22: 2135 - 2137.

3. S. Goya Wannamethee, PhD; Gordon D.O. Lowe, MD; Peter H. Whincup, FRCP; Ann Rumley, PhD; Mary Walker, MA; Lucy Lennon, BScPhysical Activity and Hemostatic and Inflammatory Variables in Elderly Men Circulation. 2002;105:1785.

4. T.S. Church; C.E. Barlow; C.P. Earnest; J.B. Kampert; E.L. Priest; S.N. Blair. Associations Between Cardiorespiratory Fitness and C-Reactive Protein in Men Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1869.

5. Konig D, Deibert P, Winkler K, Berg A. Association between LDL-cholesterol, statin therapy, physical activity and inflammatory markers in patients with stable coronary heart disease. Exerc Immunol Rev. 2005;11:97-107.