title: Men with lower HDL cholesterol levels have significant increment of soluble CD40 ligand and high-sensitivity CRP levels following the cessation of long-term clopidogrel therapy.
abstract: OBJECTIVE
  The aim of this study was to examine whether the termination of long-term clopidogrel therapy results in a proinflammatory state and whether lipid parameters influence the inflammatory response after stopping the drug.
  
  
  METHODS
  A prospective, multicenter study was conducted among 200 patients with implanted coronary stents who received dual antiplatelet therapy for one year, without ischemic or bleeding events. According to the guidelines, clopidogrel was discontinued after one year. In all patients, the high-sensitivity C-reactive protein (hsCRP), soluble CD40 ligand (sCD40L) and lipid [total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)] levels were measured twice: on the day of cessation of clopidogrel and 45 days after the termination of clopidogrel treatment.
  
  
  RESULTS
  In men (n=151), the sCD40L serum levels were significantly higher 45 days after the discontinuation of clopidogrel (p=0.007), while the hsCRP levels were not significantly different (p=0.407). Furthermore, when analyzed across the HDL-C quartiles, the hsCRP and sCD40L values were found to be associated with the levels of HDL-C after the discontinuation of clopidogrel in men. In addition, the men in the first HDL-C quartile exhibited the most pronounced increase in the sCD40L levels (p=0.001) and had significantly higher hsCRP levels (p=0.001) compared to the subjects in the other quartiles. Other lipid parameters did not show any associations with the sCD40L or hsCRP levels.
  
  
  CONCLUSIONS
  The discontinuation of clopidogrel is associated with higher increments in the sCD40L level, and a pronounced proinflammatory response is associated with a lower HDL-C concentration.
authors.affiliation: Clinic of Emergency Medicine, Military Medical Academy, Medical Faculty, University of Defense.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Obradovic
authors.forename: Nina
authors.initials: N
authors.lastname: Djukanovic
authors.forename: Zoran
authors.initials: Z
authors.lastname: Todorovic
authors.forename: Ivanka
authors.initials: I
authors.lastname: Markovic
authors.forename: Danijela
authors.initials: D
authors.lastname: Zamaklar-Trifunovic
authors.forename: Dragana
authors.initials: D
authors.lastname: Protic
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostojic
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D023201:CD40 Ligand / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D000077144:Clopidogrel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D008076:Cholesterol, HDL; D010975:Platelet Aggregation Inhibitors; D023201:CD40 Ligand; D002097:C-Reactive Protein; D000077144:Clopidogrel; D013988:Ticlopidine