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Strong decrease of high sensitivity C-reactive protein with high-dose atorvastatin in patients with type 2 diabetes
M A van de Ree1, M V Huisman, H M G Princen
1Department of General Internal Medicine, B3-Q83, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Insights
High-dose atorvastatin significantly reduces C-reactive protein (CRP) levels in patients with type 2 diabetes (DM2). This potent anti-inflammatory effect, independent of lipid changes, may enhance cardiovascular protection.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Statins are known to reduce C-reactive protein (CRP) levels.
- The comparative efficacy of high-dose statins for CRP reduction remains unclear.
Purpose of the Study:
- To investigate the dose-dependent effect of atorvastatin on high-sensitivity C-reactive protein (hs-CRP) levels in patients with type 2 diabetes (DM2).
- To determine if high-dose atorvastatin offers superior CRP reduction compared to standard doses.
Main Methods:
- A prospective, double-blind, multicenter study involving 186 DM2 patients with dyslipidemia but no manifest coronary artery disease.
- Patients received 30-week treatments of 10 mg atorvastatin, 80 mg atorvastatin, or placebo.
- hs-CRP levels were measured to assess treatment efficacy.
Main Results:
- Median CRP levels increased by 6.6% in the placebo group.
- Atorvastatin significantly reduced CRP by 15% (10 mg) and 47% (80 mg) (P<0.001).
- 80 mg atorvastatin led to 56% of patients achieving CRP < 3.0 mg/L, compared to 23% (10 mg) and 17% (placebo).
Conclusions:
- High-dose atorvastatin (80 mg) significantly reduces CRP levels in DM2 patients.
- The observed CRP reduction is largely independent of lipid-lowering effects and IL-6 changes.
- The potent anti-inflammatory action of high-dose atorvastatin may contribute to its cardioprotective benefits in high-risk individuals.
Objective:
Statins are known to reduce CRP concentrations, but whether high doses are more effective is not known.
Methods:
In a prospective double-blind multicenter study in 186 DM2 patients without manifest coronary artery disease and with dyslipidemia, the effect of a 30-week treatment with 10 and 80 mg atorvastatin or placebo on the reduction of hs-CRP levels was measured.
Results:
Median CRP levels increased with 6.6% in the placebo group and were reduced by 15 and 47%, respectively, with atorvastatin 10 and 80 mg (P<0.001; significantly different from 10 mg atorvastatin and from placebo (P<0.001). Variation in IL-6 and plasma lipids associated for 21 and 8%, respectively, with variation in CRP levels (P<0.001 and P=0.01). Of patients with a baseline CRP level above an arbitrary threshold of 3.0 mg/l, 56% in the 80 mg atorvastatin group reached a level of less than 3.0 mg/l, versus 23% randomized to 10 mg atorvastatin (P<0.01) and 17% in the placebo group (P<0.005).
Conclusions:
In DM2 patients high dose atorvastatin induced a strong reduction in CRP levels. The decrease in CRP was mainly independent of effects on lipid lowering and changes in IL-6 levels. The pleiotropic effect of high-dose atorvastatin on inflammation could add to its cardioprotective effect in high-risk patients.
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