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Highly Effective Reduction of C-Reactive Protein in Patients With Coronary Heart
Disease by Extracorporeal Low-Density Lipoprotein Apheresis
Atherosclerosis
2002;162:187-191.
Eberhard Wieland, Volker Schettler, Victor William Armstrong
C-reactive protein (CRP) is a sensitive marker of inflammation also found to be
associated with coronary heart disease (CHD). CRP has been found in atherosclerotic
lesions, and a causal relationship has been suggested between CRP deposition and
the inflammatory reaction in the vessel wall. As a result, reduction of CRP levels,
even from normal concentrations, may prove to be therapeutic. The authors hypothesized
that treatment with the heparin-induced LDL-apheresis method may result in more
significant reductions in CRP levels than those seen with statin use alone. CRP
concentrations were determined from the serum of hypercholesterolemic patients with
CHD (n=13) both pre- and postapheresis. In addition, the effect of the heparin-induced
method on serum CRP concentrations in vitro was also determined.
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The heparin-induced method significantly reduced CRP concentrations by an average
of 65% (3.09 mg/L [0.22-6.11] – 1.07 [0.10-3.08]; P<0.001). This
was comparable with the 64% average reduction in LDL-C in the same samples. |
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CRP was partly co-precipitated with LDL-C in agreement with previous studies, which
show that other plasma proteins are co-precipitated with the heparin-induced method.
In vitro precipitation achieved 100% removal of LDL-C, whereas CRP concentrations
were lowered by approximately 67%. |
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Kinetic studies demonstrated that, in contrast to LDL-C, the rate of return of CRP
concentrations to preapheresis values showed larger fluctuations. A sustained decrease
in CRP levels was observed in four of six patients over the first 4 days following
apheresis.
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The authors conclude that the heparin-induced method efficiently and effectively
lowers CRP concentrations in patients with CHD. This information may help explain
the stabilization and reduction in atherosclerotic plaques seen in hypercholesterolemic
patients following LDL-apheresis treatment. |
Click for full abstract.
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