title: Effect of beta blockers (metoprolol or propranolol) on effect of simvastatin in lowering C-reactive protein in acute myocardial infarction.
abstract: Recent data indicated that statin therapy may fail to reduce the incidence of coronary events in patients concomitantly using beta blockers. The aim of the present study was to examine whether the concomitant use of beta blockers would modify the anti-inflammatory action of statins. Changes in C-reactive protein (CRP) between days 1 and 5 after myocardial infarction were evaluated in 189 patients treated with simvastatin alone (S), beta blockers alone (B; propranolol or metoprolol), S + B, or neither of these 2 medications (N) in a prospective observational cohort. At baseline, median CRP was lower in the S group (0.40 mg/dl, interquartile range 0.1 to 0.6) than the other groups (B: 0.6 mg/dl, interquartile range 0.4 to 1.6; S + B: 0.5 mg/dl, interquartile range 0.3 to 1.2; and N: 0.6 mg/dl, interquartile range 0.2 to 1.5). By day 5, median CRP was 1.3 mg/dl (interquartile range 0.7 to 2.6), 4.3 (interquartile range 1.6 to 8.8), 4.6 (interquartile range 2.8 to 9.5), and 4.4 (interquartile range 1.9 to 9.9) for the S, B, S + B, and N groups, respectively. After adjusting for log(e) baseline CRP, the difference in log(e) CRP between days 1 and 5 was significantly lower in the S group compared with the B (-0.74 +/- 0.23 [SE], p = 0.001) or S + B group (-0.99 +/- 0.20 [SE], p <0.0001). The significance remained after adjustment for age, gender, and baseline CRP. There was no significant difference in change in CRP between the SB and B groups. In conclusion, the present study confirmed the anti-inflammatory action of statins and showed that concomitant use of beta blockers may significantly attenuate this effect.
authors.affiliation: University of Brasilia Medical School, Brazil.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Quinaglia e Silva
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Munhoz
authors.forename: Tiago N
authors.initials: TN
authors.lastname: Morato
authors.forename: Augusto
authors.initials: A
authors.lastname: Gurgel
authors.forename: Antonio C T
authors.initials: AC
authors.lastname: Macedo
authors.forename: Peter
authors.initials: P
authors.lastname: Sever
authors.forename: Andrei C
authors.initials: AC
authors.lastname: Sposito
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008790:Metoprolol / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy*; D011433:Propranolol / Q000494:pharmacology / Q000627:therapeutic use; D019821:Simvastatin / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein; D011433:Propranolol; D019821:Simvastatin; D008790:Metoprolol