MONDAY, Jan. 13, 2003 (HealthDayNews) -- New evidence that cardiovascular disease is at least in part an inflammatory condition comes from a new Swiss study that shows an anti-inflammatory drug benefits heart patients.
The results are hardly definitive, since the study included only 14 patients. However, the finding was important enough to be put on today's "rapid track" report of Circulation, which is reserved for work that has "major clinical impact or represents important basic science discoveries."
In the study, a group led by Dr. Frank Ruschitzka, an assistant professor of medicine at the University Hospital in Zurich, gave the anti-inflammatory drug celecoxib, marketed as Celebrex, to some of the patients, all with severe heart disease, for two weeks. The other patients received a placebo.
Then the two groups switched treatments.
The researchers measured factors important in heart disease, such as function of the endothelium, the delicate lining of the arteries; levels of C-reactive protein, a molecule associated with inflammation; and levels of LDL cholesterol, the "bad" cholesterol that clogs arteries.
Celebrex is a COX-2 inhibitor, a member of a new family of drugs that are "potent anti-inflammatory agents, and inflammation is of utmost importance in atherosclerosis," Ruschitzka says.
The study results warrant a large-scale clinical trial to test the drug's use in heart disease, he says.
When the patients got celecoxib, their endothelium relaxed so the arteries expanded by 3.3 percent, compared to just 2 percent when they got a placebo. Levels of C-reactive protein were 1.3 milligrams per liter with celecoxib, compared to 1.8 milligrams per liter with a placebo. And levels of LDL cholesterol were 43.6 units with celecoxib, versus 47.6 with the placebo.
Celecoxib also improved the beneficial effect of nitric oxide, which acts on the endothelium to expand blood vessels, the report says.
Those results are clinically significant, Ruschitzka says. "This is the first study to show that this regimen improves function," he says. Three other papers on studies by other researchers showing similar results will appear soon, he says.
"I would like to see an endpoint clinical trial," Ruschitzka says. "But even if one started today, the results would not be available for three to five years."
Despite the study's promising findings, he says, "I would be cautious about giving recommendations to physicians on the basis of such a small trial."
The journal report says the study results "suggest that COX-2 treatment with celecoxib has potential for add-on therapy to standard therapy," such as cholesterol-reducing statins.
Celecoxib was used in the study because not all COX-2 inhibitors might produce the same results, Ruschitzka says. "Studies in rodents point to some differences between them," he says.
The American Heart Association (AHA) says the warning signs of inflammation, notably C-reactive protein, deserve consideration, along with more traditional risk factors, such a cholesterol levels, when trying to determine a person's risk of heart disease and stroke.
"We believe C-reactive protein measurement should be seriously evaluated as part of a strategy in assessing an individual's global cardiovascular disease risk," Dr. Robert O. Bonow, professor of medicine at Northwestern University and president of the association, says in a statement on the AHA's Web site.
More information
You can get more information about the role of inflammation in cardiovascular disease from the American Heart Association. For more on heart disease, visit the National Institutes of Health.
