As high-sensitivity C-reactive protein levels provide prognostic information in addition to traditional risk factors for coronary heart disease, it is of interest to know how medications can be used to lower CRP. In this presentation Dr. Ballantyne presents studies on the effects of lipid-lowering drugs on CRP levels.

An early study by Ridker et al. published in 1999 showed that the lipid-lowering drug pravastatin reduced the risk of coronary heart disease and CRP levels, and the reduction in CRP was not related to the reduction in LDL cholesterol. Since then numerous studies have reported CRP lowering with other statins, so this is seen as a class effect. Statins do not however all lower CRP to the same extent.

Ezetimibe when combined with statins was shown to cause further reductions in CRP, although ezetimibe alone caused no reduction in CRP. Studies with fibrates have had less consistent results compared to statin trials. Fibrates were shown to lower CRP in specific groups of patients, those with mixed hyperlipidemia or the metabolic syndrome. Other therapies include niacin and bile acid-binding resins, for which more studies are needed to determine their effects on CRP.

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After viewing this presentation the participant will be able to discuss studies pertaining to CRP lowering with the following lipid-lowering drugs:

- Statins
- Ezetimibe plus/minus statin
- Fibrates
- Other therapies

Christie M. Ballantyne, MD; John Houri, MD; Alberto Notarbartolo, MD; Lorenzo Melani, MD; Leslie J. Lipka, MD, PhD; Ramachandran Suresh, PhD; Steven Sun, PhD; Alexandre P. LeBeaut, MD; Philip T. Sager, MD; Enrico P. Veltri, MD, for the Ezetimibe Study Group.Effect of Ezetimibe Coadministered With Atorvastatin in 628 Patients With Primary Hypercholesterolemia
Circulation 2003.107:2409.

Christopher P. Cannon, M.D., Eugene Braunwald, M.D., Carolyn H. McCabe, B.S., Daniel J. Rader, M.D., Jean L. Rouleau, M.D., Rene Belder, M.D., Steven V. Joyal, M.D., Karen A. Hill, B.A., Marc A. Pfeffer, M.D., Ph.D., Allan M. Skene, Ph.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 Investigators.Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes NEJM.2004;Volume 350:1495-1504.

Cortellaro M, Cofrancesco E, Boschetti C, Cortellaro F, Mancini M, Mariani M, Paoletti R.Effects of fluvastatin and bezafibrate combination on plasma fibrinogen, t-plasminogen activator inhibitor and C reactive protein levels in coronary artery disease patients with mixed hyperlipidaemia (FACT study). Fluvastatin Alone and in Combination Treatment.Thromb Haemost. 2000 Apr;83(4):549-53.

Despres JP, Lemieux I, Pascot A, Almeras N, Dumont M, Nadeau A, Bergeron J, Prud'homme D.Gemfibrozil Reduces Plasma C-Reactive Protein Levels in Abdominally Obese Men With the Atherogenic Dyslipidemia of the Metabolic Syndrome Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:702.

de Maat MP, Knipscheer HC, Kastelein JJ, Kluft C.Modulation of plasma fibrinogen levels by ciprofibrate and gemfibrozil in primary hyperlipidaemia.Thromb Haemost. 1997 Jan;77(1):75-9.

I. Jialal, MD, PhD; D. Stein, MD; D. Balis, MD; S. M. Grundy, MD, PhD; B. Adams-Huet, MS; S. Devaraj, PhD. Effect of Hydroxymethyl Glutaryl Coenzyme A Reductase Inhibitor Therapy on High Sensitive C-Reactive Protein Levels Circulation. 2001;103:1933.

Steven E. Nissen, MD; E. Murat Tuzcu, MD; Paul Schoenhagen, MD; B. Greg Brown, MD; Peter Ganz, MD; Robert A. Vogel, MD; Tim Crowe, BS; Gail Howard, MS; Christopher J. Cooper, MD; Bruce Brodie, MD; Cindy L. Grines, MD; Anthony N. DeMaria, MD; for the REVERSAL Investigators. name here JAMA.2004;Vol. 291 No. 9.

Paul M. Ridker, MD; Nader Rifai, PhD; Marc A. Pfeffer, MD; Frank Sacks, MD; Eugene Braunwald, MD; for the Cholesterol and Recurrent Events (CARE) Investigators. Long-Term Effects of Pravastatin on Plasma Concentration of C-reactive Protein Circulation. 1999;100:230-235.

Tzung-Dau Wang, Wen-Jone Chen, Jong-Wei Lin, Ching-Chih Cheng, Ming-Fong Chen and Yuan-Teh Lee.Efficacy of fenofibrate and simvastatin on endothelial function and inflammatory markers in patients with combined hyperlipidemia: relations with baseline lipid profiles Atherosclerosis.2003;170(2):315-323.