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Influence of the angiotensin converting enzyme inhibitor ramipril on high-sensitivity C-reactive protein (hs-CRP) in patients with documented atherosclerosis

Einfluss des Angiotensin-Converting-Enzyme-Hemmers Ramipril auf das hochsensitive C-reaktive Protein bei Patienten mit Atherosklerose

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Zusammenfassung

In den letzten Jahren konnte die Rolle des Renin-Angiotensin-Systems im Rahmen der inflammatorischen Prozesse immer besser erkannt werden. Der Einfluss einer ACE-Hemmer-Therapie auf diesen Prozess ist jedoch nicht völlig geklärt worden. Ziel dieser Studie war es, den Effekt einer Therapie mit dem ACE-Hemmer Ramipril auf hs-CRP bei Patienten mit Atherosklerose zu untersuchen.

Methoden und Ergebnisse

24 Patienten mit angiographisch gesicherter Atherosklerose wurden in diese prospektive, unkontrollierte, offene Multizenterstudie eingeschlossen. Weitere Einschlusskriterien waren ein baseline CRP-Spiegel zwischen 3 und 12 mg/l, ein LDL-Cholesterin <150 mg/dl und keine Vorbehandlung mit einem ACE-Hemmer bzw. Angiotensin-Rezeptorblocker. 10 Patienten wurden mit einem Statin vorbehandelt und 10 Patienten waren ohne begleitende Statintherapie. Vier Patienten wurden von der Analyse ausgeschlossen. Nach dreimonatiger Therapie mit 10 mg Ramipril täglich wurde das Ausgangs hs-CRP signifikant von 3,99±1,61 mg/l auf 2,72±1,19 mg/l gesenkt (p=0,0002). Der Abfall war in der Statin unbehandelten Gruppe ausgeprägter als in der Statin behandelten Gruppe (–1,50 mg/l ±1,44 mg/l versus—0,90 mg/l ±0,93 mg/l).

Schlussfolgerung

Der ACE-Hemmer Ramipril senkt in einer täglichen Dosierung von 10 mg die hoch-sensitive C-reaktive Protein-Konzentration. Dieser Effekt könnte zur der mit Ramipril erzielten kardiovaskulären Riskoreduktion über den Blutdrucksenkungseffekt hinaus beitragen.

Summary

Some medications have been shown to produce reductions in hs-CRP levels after initiating therapy. Whereas the role of the renin-angiotensin system in the inflammatory process has been documented in more detail during the last few years, the impact of an ACE-inhibitor therapy on this process has not been fully understood so far. The aim of this study was to investigate the effect of a therapy with the angiotensin-converting enzyme (ACE) inhibitor ramipril on hs-CRP plasma concentrations in patients with atherosclerosis.

Methods and results

A total of 24 patients were enrolled in this prospective, uncontrolled, open-label multicenter study. Inclusion criteria were documented atherosclerosis, baseline high-sensitivity C-reactive protein between 3 and 12 mg/l, LDL-Cholesterol ≤150 mg/dl and no previous treatment with ACE inhibitors or angiotensin receptor blockers. Ten patients, pretreated with statins, and 10 patients not previously treated with statins were eligible for statistical analysis. Baseline high-sensitivity C-reactive protein was significantly decreased from 3.99±1.61 mg/l (mean±SD) to 2.72±1.19 mg/l (–32%) after 3 months treatment with 10 mg ramipril daily (p=0.0002). The decrease was more pronounced in patients who had not been treated with statins previously (–1.50 mg/l±1.44 mg/l) compared to those who were pretreated (–0.90 mg/l±0.93 mg/l).

Conclusions

The ACE inhibitor ramipril administered in a daily dose of 10 mg to patients with atherosclerosis reduces the high-sensitivity C-reactive protein concentration. This effect may contribute to cardiovascular risk reduction mediated by ramipril aside from the blood pressure lowering effect.

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Authors and Affiliations

  1. Kerckhoff-Klinik GmbH, Benekestr. 2–8, 61231, Bad Nauheim, Germany

    V. Mitrovic, N. Krekel & C. W. Hamm

  2. Klinikum Idar-Oberstein GmbH, Medizinische Klinik 2, Dr.-Ottmar-Kohler-Str. 2, 55743, Idar-Oberstein, Germany

    H. H. Klein

  3. St. Vincenz Krankenhaus, Medizinische Klinik, Abt. Kardiologie, Auf dem Schafsberg, 65549, Limburg/Lahn, Germany

    J. Kreuzer

  4. Klinikum der J. W. Goethe-Universität, Medizinische Klinik IV, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    S. Fichtlscherer

  5. Aventis Pharma Deutschland GmbH, Medizinische Abteilung—Klinische Entwicklung, Kardiologie und Thrombose, Königsteiner Str. 10, 65812, Bad Soden, Germany

    A. Schirmer & W. D. Paar

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  1. V. Mitrovic
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Mitrovic, V., Klein, H.H., Krekel, N. et al. Influence of the angiotensin converting enzyme inhibitor ramipril on high-sensitivity C-reactive protein (hs-CRP) in patients with documented atherosclerosis. ZS Kardiologie 94, 336–342 (2005). https://doi.org/10.1007/s00392-005-0222-5

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  • DOI: https://doi.org/10.1007/s00392-005-0222-5

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