1. Saini NK et al
Source Journal: Inventi Rapid: Pharmacy Practice
Vol.2011, Issue 2
2. Introduction
C-reactive protein plays a role in the expression of
different adhesion molecules on endothelial cells
and the protein is able to activate human
complement within the plaque.
It has been proven that an elevated CRP level is
associated with an increased risk of occlusive
arterial disease.
3. C-Reactive protein
C-reactive protein is an acute phase protein,
the levels of which rise in response to
inflammation, microbial infection.
CRP serves as a critical component of the
innate immune system by enhancing the
uptake of microbes by phagocytic cells of
the immune system.
4. Normal CRP levels
C-Reactive protein normal: 0-1.0mg/dl (or) 10mg/L (SI Units)
The hs-CRP test measures the risk for cardiovascular problems.
It may be done to find out an increased chance of having a
sudden heart problem, such as a heart attack.
High-sensitivity C-reactive protein (hs-CRP) levels
Less than 1.0mg/L Lowest risk
1.0-3.0mg/L Average risk
More than 3.0mg/L Highest risk
5. Atorvastatin
Atorvastatin is a synthetic HMG-CoA reductase
inhibitor with a great potency to lower both cholesterol
and triglyceride concentrations.
Controlled studies with various groups of
hyperlipidemic patients showed reduction of LDL
cholesterol by up to 60% and triglyceride by up to
50%.
Mechanism of action:
Inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A
reductase, the rate limiting enzyme in cholesterol synthesis.
7. Pleiotropy of statins
Statins have been shown to decrease ROS production
and VSMC proliferation, enhances eNOS levels
exhibit anti-thrombotic and anti-inflammatory effects
thereby, attenuate artherosclerotic plaques.
Trials using different statins, including pravastatin,
simvastatin and atorvastatin have all demonstrated
favourable reductions in C-reactive protein level.
VSMC-Vascular Smooth Muscle Cell
8. Role of Atorvastatin on CRP level
Atorvastatin improves endothelium dependent
vasodilatation and a lowering of plasma CRP
concentrations.
It has been demonstrated that statins have an effect on
markers of inflammation, particularly C-reactive
protein, independent of their lipid lowering effect.
Novel route of plaque attenuation: Artherosclerotic
plaque growth may be attenuated with therapy aimed at
minimizing inflammation.
9. Artherosclerotic plaque attenuatuion
through CRP level reduction
Increased levels of C-reactive protein have associated with
arterial wall inflammation.
Thus reduction in CRP levels may reduce the extent of
endothelial-cell opsonisation, macrophage recruitment and
blunting of nitric oxide release.
Prevention of vasoconstriction by attenuating the pro-
inflammatory process and preserving vasodilatation may
allow sufficient perfusion to prevent myocardial ischemia.
12. Clinical trials
Name of the study Type Drug % Reduction in
CRP level
MIRACL Randomized
controlled trial
Atorvastatin 83%
CURVES Comparative dose
efficacy study
Pravastatin,
Simvastatin,
Atorvastatin
Significant
TexCAPS Randomized
placebo controlled
trial
Lovastatin 14.8%
PRINCE trial Antiinflammatory
effects
Pravastatin 16.9%
REVERSAL Atorvastatin
Pravastatin
36.4%
5.2%
13. Inference
The use of statins may prevent ischemia by
both inhibiting deposition of lipids and
decreasing inflammation.
Atorvastatin also lowers plasma LDL
cholesterol and C-reactive protein in type-2
diabetic patients, therefore could be a useful
medication for the prevention of
cardiovascular diseases in diabetic patients.
