C-Reactive Protein (CRP)-Lowering Agents Kailash Prasad Department of Physiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Keywords: ACE-inhibitors — Angiotensin receptor blockers — Antidiabetic agents — Antioxidants — Atherosclerosis — â-Adrenoreceptor antagonists — Calcium channel antagonists — Cardiovascular disease — Cholesterol — C-re- active protein — CRP-lowering agent — Cyclooxygenase inhibitors — Estro- gen — Ezetimibe — Oxygen radicals — Statins. ABSTRACT C-reactive protein (CRP) plays a role in the pathogenesis of cardiovascular disease. It is a marker and predictor of cardiovascular disease. CRP possesses numerous cardiovas- cular effects (clotting, generation of oxygen radicals, increase in the expression of ad- hesion molecules and plasminogen activator inhibitor-1, plaque destabilization) that could result in cardiovascular disease. This review describes the effects of various cardiovas- cular drugs on the levels of CRP in health and disease. Cyclooxygenase inhibitors (aspirin, rofecoxib, celecoxib), platelet aggregation inhibitors (clopidogrel, abciximab), lipid low- ering agents (statins, ezetimibe, fenofibrate, niacin, diets), â-adrenoreceptor antagonists and antioxidants (vitamin E), as well as angiotensin converting enzyme (ACE) inhibitors (ramipril, captopril, fosinopril), reduce serum levels of CRP; while enalapril and trandola- pril have not been shown to have the same effect. Angiotensin receptor blockers (ARBs) (valsartan, irbesartan, olmesartan, telmisartan) markedly reduce serum levels of CRP. The findings with other ARBs (losartan and candesartan) were inconsistent. Antidiabetic agents (rosiglitazone and pioglitazone) reduce CRP levels, while insulin is ineffective. Calcium channel antagonists have variable effects on CRP levels. Hydrochlorothiazide and oral estrogen do not affect CRP. The CRP-lowering effect of statins is more pro- nounced than their lipid lowering effect and is not dependent on their hypolipemic ac- tivity. The effect of atorvastatin on CRP seems to be dose-dependent. CRP-lowering effect of statins is likely to contribute to the favorable outcome of statin therapy. The data suggest that lipid lowering agents, ACE inhibitors, ARBs, antidiabetic agents, antiinflam- matory and antiplatelet agents, vitamin E, and â-adrenoreceptor antagonists lower serum or plasma levels of CRP, while vitamin C, oral estrogen and hydrochlorothiazide do not affect CRP levels. 33 Cardiovascular Drug Reviews Vol. 24, No. 1, pp. 33–50 © 2006 The Authors Journal compilation © 2006 Blackwell Publishing, Inc. Address correspondence and reprint requests to: K. Prasad, M.D., Ph.D., FRCPC, FACC, FICA, Department of Physiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada. Tel.: +1 (306) 966-6539, Fax: +1 (306) 966-6532, E-mail: prasadk@usask.ca