Abstract
Background: The aim of this study was to evaluate how the high sensitivity C-reactive protein (hs-CRP) values influence the risk of carotid plaque instability in association with other cardiovascular risk factors. Methods: One hundred and fifty-six carotid plaques from both symptomatic and asymptomatic patients requiring surgical carotid endarterectomy were retrospectively collected. According to the modified American Heart Association, atherosclerosis plaques have been histologically distinguished into unstable and stable. The following anamnestic and hematochemical data were also considered: age, gender, hypertension, diabetes mellitus, smoking habit, therapy, low-density lipoprotein (LDL)-C, kidney failure and hs-CRP. Results: The results of our study clearly show that high levels of hs-CRP significantly increase the carotid plaque instability in dyslipidemic patients. Specifically, a 67% increase of the risk of carotid plaque instability was observed in patients with high LDL-C. Therefore, the highest risk was observed in male dyslipidemic patients 2333 (95% CI 0.73–7.48) and in aged female patients 2713 (95% CI 0.14–53.27). Discussion: These data strongly suggest a biological relationship between the hs-CRP values and the alteration of lipidic metabolism mostly in male patients affected by carotid atherosclerosis. The measurement of hs-CRP might be useful as a potential screening tool in the prevention of atheroscletotic disease.
Highlights
Atherosclerosis is a pathological condition characterized by a chronic active inflammatory condition of the major arteries leading to the development of intimal plaques [1,2,3,4]
It is possible to hypothesize that high sensitivity C-reactive protein (hs-C-reactive protein (CRP)) may increase the plaque rupture risk in synergy with the simultaneous presence of other cardiovascular risk factors. Starting from these considerations, the aim of this study was to evaluate how the hs-CRP values influence the risk of carotid plaque instability in association with other cardiovascular risk factors such as age, gender, hypertension, diabetes, smoking habit, low HDL and high low-density lipoprotein (LDL)-C
Concerning the case selection investigated here, the hs-CRP does not represent an independent risk factor for carotid plaque instability if not associated with other risk factors (odds ratio 1.03)
Summary
Atherosclerosis is a pathological condition characterized by a chronic active inflammatory condition of the major arteries leading to the development of intimal plaques [1,2,3,4]. With regard to the atherosclerosis of carotids, a recent meta-analysis and modelling study [9] analyzed data in people aged 30–79 and found that the prevalence of carotid plaque was about 816 million cases, and that of carotid stenosis was about 58 million cases in 2020. These data highlight the impact of carotid atherosclerosis on human life and put the emphasis on the need to improve our understanding about the mechanisms explaining the development of cardiovascular adverse events. The measurement of hs-CRP might be useful as a potential screening tool in the prevention of atheroscletotic disease
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