Current Atherosclerosis Reports

, Volume 4, Issue 1, pp 42–47 | Cite as

Statins and inflammatory markers

  • Christopher C. Case
  • Christie M. Ballantyne
Article

Abstract

Inflammation is involved in the initiation and progression of atherosclerosis and the development of atherosclerotic events. Understanding of the molecular basis of inflammation has led to the identification of markers that may be important new targets in atherothrombotic disease. Inflammatory markers, such as cell adhesion molecules, cytokines, and high-sensitivity C-reactive protein, have been shown to predict future cardiovascular events in individuals with and without established disease. 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, or statins, inhibit the synthesis of cholesterol and have been demonstrated to reduce cardiovascular morbidity and mortality. Recently, statins have been shown to modulate several of the mechanisms of inflammation in atherosclerosis in vitro and in vivo, including reduction of inflammatory markers in clinical trials. In this article, we briefly review the biology, epidemiology, and clinical trial data on the effects of statins on some of the more promising inflammatory markers.

Keywords

Simvastatin Pravastatin Lovastatin Statin Therapy Rosuvastatin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Braunwald E: Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 1997, 337:1360–1369.PubMedCrossRefGoogle Scholar
  2. 2.
    Ross R: Atherosclerosis—an inflammatory disease. N Engl J Med 1999, 340:115–126.PubMedCrossRefGoogle Scholar
  3. 3.
    Poston RN, Haskard DO, Coucher JR, Gall NP, Johnson-Tidey RR: Expression of intercellular adhesion molecule-1 in atherosclerotic plaques. Am J Pathol 1992, 140:665–673.PubMedGoogle Scholar
  4. 4.
    Gearing AJ, Newman W: Circulating adhesion molecules in disease. Immunol Today 1993, 14:506–512.PubMedCrossRefGoogle Scholar
  5. 5.
    Hackman A, Abe Y, Insull W Jr, et al.: Levels of soluble cell adhesion molecules in patients with dyslipidemia. Circulation 1996, 93:1334–1338.PubMedGoogle Scholar
  6. 6.
    Davi G, Romano M, Mezzetti A, et al.: Increased levels of soluble P-selectin in hypercholesterolemic patients. Circulation 1998, 97:953–957.PubMedGoogle Scholar
  7. 7.
    Blann AD, Tse W, Maxwell SJ, Waite MA: Increased levels of the soluble adhesion molecule E-selectin in essential hypertension. J Hypertens 1994, 12:925–928.PubMedCrossRefGoogle Scholar
  8. 8.
    Steiner M, Reinhardt KM, Krammer B, Ernst B, Blann AD: Increased levels of soluble adhesion molecules in type 2 (non-insulin dependent) diabetes mellitus are independent of glycaemic control. Thromb Haemost 1994, 72:979–984.PubMedGoogle Scholar
  9. 9.
    Ridker PM, Hennekens CH, Roitman-Johnson B, Stampfer MJ, Allen J: Plasma concentration of soluble intercellular adhesion molecule 1 and risks of future myocardial infarction in apparently healthy men. Lancet 1998, 351:88–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Hwang SJ, Ballantyne CM, Sharrett AR, et al.: Circulating adhesion molecules VCAM-1, ICAM-1, and E-selectin in carotid atherosclerosis and incident coronary heart disease cases: the Atherosclerosis Risk In Communities (ARIC) study. Circulation 1997, 96:4219–4225.PubMedGoogle Scholar
  11. 11.
    Malik I, Danesh J, Whincup P, et al.: Soluble adhesion molecules and prediction of coronary heart disease: a prospective study and meta-analysis. Lancet 2001, 358:971–976.PubMedCrossRefGoogle Scholar
  12. 12.
    Ridker PM, Hennekens CH, Buring JE, Rifai N: C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000, 342:836–843.PubMedCrossRefGoogle Scholar
  13. 13.
    Ridker PM, Buring JE, Rifai N: Soluble P-selectin and the risk of future cardiovascular events. Circulation 2001, 103:491–495.PubMedGoogle Scholar
  14. 14.
    Rohde LE, Lee RT, Rivero J, et al.: Circulating cell adhesion molecules are correlated with ultrasound-based assessment of carotid atherosclerosis. Arterioscler Thromb Vasc Biol 1998, 18:1765–1770.PubMedGoogle Scholar
  15. 15.
    Blankenberg S, Rupprecht HJ, Bickel C, et al.: Circulating cell adhesion molecules and death in patients with coronary artery disease. Circulation 2001, 104:1336–1342.PubMedGoogle Scholar
  16. 16.
    de Lemos JA, Hennekens CH, Ridker PM: Plasma concentration of soluble vascular cell adhesion molecule-1 and subsequent cardiovascular risk. J Am Coll Cardiol 2000, 36:423–426.PubMedCrossRefGoogle Scholar
  17. 17.
    Nelken NA, Coughlin SR, Gordon D, Wilcox JN: Monocyte chemoattractant protein-1 in human atheromatous plaques. J Clin Invest 1991, 88:1121–1127.PubMedCrossRefGoogle Scholar
  18. 18.
    Gu L, Okada Y, Clinton SK, et al.: Absence of monocyte chemoattractant protein-1 reduces atherosclerosis in low density lipoprotein receptor-deficient mice. Mol Cell 1998, 2:275–281.PubMedCrossRefGoogle Scholar
  19. 19.
    Kowala MC, Recce R, Beyer S, Gu C, Valentine M: Characterization of atherosclerosis in LDL receptor knockout mice: macrophage accumulation correlates with rapid and sustained expression of aortic MCP-1/JE. Atherosclerosis 2000, 149:323–330.PubMedCrossRefGoogle Scholar
  20. 20.
    Aiello RJ, Bourassa PA, Lindsey S, et al.: Monocyte chemoattractant protein-1 accelerates atherosclerosis in apolipoprotein E-deficient mice. Arterioscler Thromb Vasc Biol 1999, 19:1518–1525.PubMedGoogle Scholar
  21. 21.
    Kowalski J, Okopien B, Madej A, et al.: Levels of sICAM-1, sVCAM-1 and MCP-1 in patients with hyperlipoproteinemia IIa and -IIb. Int J Clin Pharmacol Ther 2001, 39:48–52.PubMedGoogle Scholar
  22. 22.
    Matsumori A, Furukawa Y, Hashimoto T, et al.: Plasma levels of the monocyte chemotactic and activating factor/monocyte chemoattractant protein-1 are elevated in patients with acute myocardial infarction. J Mol Cell Cardiol 1997, 29:419–423.PubMedCrossRefGoogle Scholar
  23. 23.
    Nishiyama K, Ogawa H, Yasue H, et al.: Simultaneous elevation of the levels of circulating monocyte chemoattractant protein-1 and tissue factor in acute coronary syndromes. Jpn Circ J 1998, 62:710–712.PubMedCrossRefGoogle Scholar
  24. 24.
    Mazzone A, De Servi S, Mazzucchelli I, et al.: Increased concentrations of inflammatory mediators in unstable angina: correlation with serum troponin T. Heart 2001, 85:571–575.PubMedCrossRefGoogle Scholar
  25. 25.
    Cipollone F, Marini M, Fazia M, et al.: Elevated circulating levels of monocyte chemoattractant protein-1 in patients with restenosis after coronary angioplasty. Arterioscler Thromb Vasc Biol 2001, 21:327–334.PubMedGoogle Scholar
  26. 26.
    Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM: C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001, 286:327–334.PubMedCrossRefGoogle Scholar
  27. 27.
    Pickup JC, Mattock MB, Chusney GD, Burt D: NIDDM as a disease of the innate immune system: association of acute-phase reactants and interleukin-6 with metabolic syndrome X. Diabetologia 1997, 40:1286–1292.PubMedCrossRefGoogle Scholar
  28. 28.
    Moller DE: Potential role of TNF-alpha in the pathogenesis of insulin resistance and type 2 diabetes. Trends Endocrinol Metab 2000, 11:212–217.PubMedCrossRefGoogle Scholar
  29. 29.
    Harris TB, Ferrucci L, Tracy RP, et al.: Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly. Am J Med 1999, 106:506–512.PubMedCrossRefGoogle Scholar
  30. 30.
    Ridker PM, Rifai N, Stampfer MJ, Hennekens CH: Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men. Circulation 2000, 101:1767–1772.PubMedGoogle Scholar
  31. 31.
    Biasucci LM, Vitelli A, Liuzzo G, et al.: Elevated levels of interleukin-6 in unstable angina. Circulation 1996, 94:874–877.PubMedGoogle Scholar
  32. 32.
    Ridker PM, Rifai N, Pfeffer M, et al.: Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events after myocardial infarction. Circulation 2000, 101:2149–2153.PubMedGoogle Scholar
  33. 33.
    Kushner I, Mackiewicz A: Acute phase response: an overview. In Acute Phase Proteins: Molecular Biology, Biochemistry, and Clinical Application. Edited by Mackiewicz A, Kushner I, Baumann H. Boca Raton, FL: CRC Press; 1993:4–19.Google Scholar
  34. 34.
    Munford RS: Statins and the acute-phase response. N Engl J Med 2001, 344:2016–2018.PubMedCrossRefGoogle Scholar
  35. 35.
    Fichtlscherer S, Rosenberger G, Walter DH, et al.: Elevated C-reactive protein levels and impaired endothelial vasoreactivity in patients with coronary artery disease. Circulation 2000, 102:1000–1006.PubMedGoogle Scholar
  36. 36.
    Pasceri V, Willerson JT, Yeh ET: Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 2000, 102:2165–2168.PubMedGoogle Scholar
  37. 37.
    Pasceri V, Chang J, Willerson JT, Yeh ET: Modulation of C-reactive protein-mediated monocyte chemoattractant protein-1 induction in human endothelial cells by anti-atherosclerosis drugs. Circulation 2001, 103:2531–2534.PubMedGoogle Scholar
  38. 38.
    Zwaka TP, Hombach V, Torzewski J: C-reactive protein-mediated low density lipoprotein uptake by macrophages: implications for atherosclerosis. Circulation 2001, 103:1194–1197.PubMedGoogle Scholar
  39. 39.
    Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH: Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997, 336:973–979.PubMedCrossRefGoogle Scholar
  40. 40.
    Danesh J, Whincup P, Walker M, et al.: Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ 2000, 321:199–204.PubMedCrossRefGoogle Scholar
  41. 41.
    Lindberg G, Eklund GA, Gullberg B, Rastam L: Sialic acid and cardiovascular mortality [letter]. BMJ 1991, 302:1154.PubMedCrossRefGoogle Scholar
  42. 42.
    Ridker PM, Rifai N, Clearfield M, et al., for the Air Force/Texas Coronary Atherosclerosis Prevention Study Investigators: Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med 2001, 344:1959–1965.PubMedCrossRefGoogle Scholar
  43. 43.
    Ridker PM: High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 2001, 103:1813–1818.PubMedGoogle Scholar
  44. 44.
    Ridker PM, Rifai N, Pfeffer MA, et al. for the Cholesterol and Recurrent Events (CARE) Investigators: Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Circulation 1998, 98:839–844.PubMedGoogle Scholar
  45. 45.
    Liuzzo G, Biasucci LM, Gallimore JR, et al.: The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med 1994, 331:417–424.PubMedCrossRefGoogle Scholar
  46. 46.
    Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH: Plasma concentration of C-reactive protein and risk of developing peripheral vascular disease. Circulation 1998, 97:425–428.PubMedGoogle Scholar
  47. 47.
    Corsini A, Bellosta S, Baetta R, et al.: New insights into the pharmacodynamic and pharmacokinetic properties of statins. Pharmacol Ther 1999, 84:413–428.PubMedCrossRefGoogle Scholar
  48. 48.
    Pruefer D, Scalia R, Lefer AM: Simvastatin inhibits leukocyte-endothelial cell interactions and protects against inflammatory processes in normocholesterolemic rats. Arterioscler Thromb Vasc Biol 1999, 19:2894–2900.PubMedGoogle Scholar
  49. 49.
    Yoshida M, Sawada T, Ishii H, et al.: HMG-CoA reductase inhibitor modulates monocyte-endothelial cell interaction under physiological flow conditions in vitro: involvement of Rho GTPase-dependent mechanism. Arterioscler Thromb Vasc Biol 2001, 21:1165–1171.PubMedGoogle Scholar
  50. 50.
    Endres M, Laufs U, Huang Z, et al.: Stroke protection by 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase inhibitors mediated by endothelial nitric oxide synthase. Proc Natl Acad Sci U S A 1998, 95:8880–8885.PubMedCrossRefGoogle Scholar
  51. 51.
    Lefer AM, Campbell B, Shin YK, et al.: Simvastatin preserves the ischemic-reperfused myocardium in normocholesterolemic rat hearts. Circulation 1999, 100:178–184.PubMedGoogle Scholar
  52. 52.
    Weber C, Erl W, Weber KS, Weber PC: HMG-CoA reductase inhibitors decrease CD11b expression and CD11b-dependent adhesion of monocytes to endothelium and reduce increased adhesiveness of monocytes isolated from patients with hypercholesterolemia. J Am Coll Cardiol 1997, 30:1212–1217.PubMedCrossRefGoogle Scholar
  53. 53.
    Serrano CV Jr, Yoshida VM, Venturinelli ML, et al.: Effect of simvastatin on monocyte adhesion molecule expression in patients with hypercholesterolemia. Atherosclerosis 2001, 157:505–512.PubMedCrossRefGoogle Scholar
  54. 54.
    Romano M, Mezzetti A, Marulli C, et al.: Fluvastatin reduces soluble P-selectin and ICAM-1 levels in hypercholesterolemic patients: role of nitric oxide. J Invest Med 2000, 48:183–189.Google Scholar
  55. 55.
    Murphy RT, Foley JB, Mulvihill N, Crean P, Walsh MJ: Impact of preexisting statin use on adhesion molecule expression in patients presenting with acute coronary syndromes. Am J Cardiol 2001, 87:446–448.PubMedCrossRefGoogle Scholar
  56. 56.
    Bustos C, Hernandez-Presa MA, Ortego M, et al.: HMG-CoA reductase inhibition by atorvastatin reduces neointimal inflammation in a rabbit model of atherosclerosis. J Am Coll Cardiol 1998, 32:2057–2064.PubMedCrossRefGoogle Scholar
  57. 57.
    Romano M, Diomede L, Sironi M, et al.: Inhibition of monocyte chemotactic protein-1 synthesis by statins. Lab Invest 2000, 80:1095–1100.PubMedGoogle Scholar
  58. 58.
    Rosenson RS, Tangney CC, Casey LC: Inhibition of proinflammatory cytokine production by pravastatin [letter]. Lancet 1999, 353:983–984.PubMedCrossRefGoogle Scholar
  59. 59.
    Ferro D, Parrotto S, Basili S, Alessandri C, Violi F: Simvastatin inhibits the monocyte expression of proinflammatory cytokines in patients with hypercholesterolemia. J Am Coll Cardiol 2000, 36:427–431.PubMedCrossRefGoogle Scholar
  60. 60.
    Grip O, Janciauskiene S, Lindgren S: Pravastatin down-regulates inflammatory mediators in human monocytes in vitro. Eur J Pharmacol 2000, 410:83–92.PubMedCrossRefGoogle Scholar
  61. 61.
    Jialal I, Stein D, Balis D, et al.: Effect of hydroxymethyl glutaryl coenzyme A reductase inhibitor therapy on high sensitive C-reactive protein levels. Circulation 2001, 103:1933–1935.PubMedGoogle Scholar
  62. 62.
    Holm T, Andreassen AK, Ueland T, et al.: Effect of pravastatin on plasma markers of inflammation and peripheral endothelial function in male heart transplant recipients. Am J Cardiol 2001, 87:815–818.PubMedCrossRefGoogle Scholar
  63. 63.
    Musial J, Undas A, Gajewski P, et al.: Anti-inflammatory effects of simvastatin in subjects with hypercholesterolemia. Int J Cardiol 2001, 77:247–253.PubMedCrossRefGoogle Scholar
  64. 64.
    Ridker PM, Rifai N, Pfeffer MA, et al. 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.PubMedGoogle Scholar
  65. 65.
    Ridker PM, Rifai N, Lowenthal SP: Rapid reduction in C-reactive protein with cerivastatin among 785 patients with primary hypercholesterolemia. Circulation 2001, 103:1191–1193.PubMedGoogle Scholar
  66. 66.
    Albert MA, Danielson E, Rifai N, Ridker PM, for the PRINCE Investigators: Effect of statin therapy on C-reactive protein levels: the Pravastatin Inflammation/CRP Evaluation (PRINCE): a randomized trial and cohort study. JAMA 2001, 286:64–70.PubMedCrossRefGoogle Scholar
  67. 67.
    Roberts WL, Sedrick R, Moulton L, Spencer A, Rifai N: Evaluation of four automated high-sensitivity C-reactive protein methods: implications for clinical and epidemiological applications. Clin Chem 2000, 46:461–468.PubMedGoogle Scholar
  68. 68.
    Ballantyne CM: Rosuvastatin alone produces similar lipid benefits compared with rosuvastatin plus cholestyramine in patients with primary hypercholesterolaemia. Presented at Drugs Affecting Lipid Metabolism, XIV International Symposium, New York, New York, September 2001.Google Scholar
  69. 69.
    Feldman M, Jialal I, Devaraj S, Cryer B: Effects of low-dose aspirin on serum C-reactive protein and thromboxane B2 concentrations: a placebo-controlled study using a highly sensitive C-reactive protein assay. J Am Coll Cardiol 2001, 37:2036–2041.PubMedCrossRefGoogle Scholar
  70. 70.
    Ikonomidis I, Andreotti F, Economou E, et al.: Increased proinflammatory cytokines in patients with chronic stable angina and their reduction by aspirin. Circulation 1999, 100:793–798.PubMedGoogle Scholar
  71. 71.
    Cortellaro M, Cofrancesco E, Boschetti C, et al. on behalf of the FACT study centers: 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). Thromb Haemost 2000, 83:549–553.PubMedGoogle Scholar
  72. 72.
    de Maat MP, Knipscheer HC, Kastelein JJ, Kluft C: Modulation of plasma fibrinogen levels by ciprofibrate and gemfibrozil in primary hyperlipidaemia. Thromb Haemost 1997, 77:75–79.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Christopher C. Case
    • 1
  • Christie M. Ballantyne
    • 1
  1. 1.Baylor College of MedicineHoustonUSA

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