Monday, July 16, 2012

Initially the hs- CRP ( highly sensitive C-Reactive Protein ) test looked like another useful tool, however.....


Initially the hs- CRP ( highly sensitive C-Reactive Protein ) test looked like another useful tool for helping my patients reduce their risk of developing cardiovascular disease.  

I soon discovered that the test added more uncertainty to an already complex problem. Most of my patients were already taking medications known to reduce the levels of this inflammatory marker. I found it very difficult to explain a slightly elevated test result in a healthy, active patient with type 2 diabetes who did not smoke and was doing their best with exercise and weight control. The test could not separate the hidden inflammatory process in blood vessels from the residuals of a recent mild upper respiratory infection the week before. 

I still believe the test is useful for helping us understand the disease process but is  not useful in the clinical practice of medicine.

I have listed the common medications that have been shown to reduce this inflammatory marker

Aspirin has anti-inflammatory and anti platelet activity

Statins
   Statins are primarily used to reduce LDL cholesterol and also have a potent rapid onset anti-inflammatory effect in blood vessels
   CRP levels decline signficantly within 6 weeks of starting a Statin
   Other studies have demonstrated a reduction in ischemic events with 16 weeks of starting  a Statin
   One study the AFCAOS/TEXCAPS primary prevention trial found lovastatin to be  more effective 
    in people with elevated CRP levels .

Plavix (clopidogrel)
  Has anti -inflammatory effects  especially when combined with aspirin.This drug is useful in acute
  situations and in my experience was generally ordered and managed by a cardiologist .     


ACE inhibitors
  ACE inhibitors may provide anti-inflammatory protection by suppressing these proinflammatory
   cytokines
     
 People who stop smoking  or lose weight have a decrease in inflammatory markers.

 Exercise reduces inflammatory markers


Have fun , Be Smart and remember this good advise from my son -in-law Vinne 

            " if your not hungry enough to eat an apple , your not hungry"

David Calder, MD



Reference Articles:
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  2. Manson JE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 1999;341:650–658.
  3. Smith JK, Dykes R, Douglas JE, et al. Long-term exercise and atherogenic activity of blood mononuclear cells in persons at risk of developing ischemic heart disease. JAMA 1999;281:1722–1727.
*Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: Results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998;279:1615–1622.

*Circulation 1998;839–844.Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvostatin on early recurrent ischemic events in acute coronary syndromes: 

*The MIRACL study. A randomized controlled trial. Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. JAMA 2001;285:1711–1718.

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1 comment:

  1. I think cardiovascular disease can be avoided only by proper diet food and regular exercise. Other than this, one has to go for regular medical check up.

    http://www.diabeteshelpchannel.com/resources/

    ReplyDelete

Your comments and questions are appreciated. David Calder,MD