Relationship of high-sensitive C-reactive protein with cardiovascular risk factors, clinical presentation and angiographic profile in patients with acute coronary syndrome: An Indian perspective

Abstract

Worldwide, atherosclerotic cardiovascular disease (CVD) including coronary artery disease (CAD) is estimated to be the leading cause of death and loss of disability-adjusted life years. Unfortunately, while the incidence and prevalence of CVD is now declining in the developed countries, it continues to increase exponentially in the developing nations. Reddy reported that from 1970 to 2015, mortality from CVD was projected to almost double in the developing countries while it was projected to decline during the same period in the developed nations.1 The Global Burden of Diseases (GBD) study reported the estimated mortality from CAD in India to be roughly 1.6 million in the year 2000.2 Several modifiable and non-modifiable risk factors have been identified to cause CVD. The major modifiable risk factors include hypertension (HTN), diabetes (DM), smoking and hyperlipidemia and whereas non-modifiable risk factors include age, gender and family history of premature CAD. However, not all coronary events can be predicted by these risk factors. In particular, nearly half of all myocardial infarctions or stroke occurs among individuals without hyperlipidemia. Consequently, alternate risk assessment approaches are being explored to facilitate early and accurate identification of individuals at risk of having CVD. Since atherosclerosis is an inflammatory process, several markers of inflammation have been evaluated for this purpose. Among them, high-sensitive C-reactive protein (hs-CRP) has emerged as the most important CV risk marker. More than a simple marker of inflammation, hs-CRP may influence vascular vulnerability directly through several mechanisms including, enhanced expression of adhesive molecules, reduced nitric oxide, increased expression of endothelial PAI-1 and altered LDL uptake by macrophages. A scientific statement issued by Centre for Disease Control (CDC) and American Heart Association (AHA) has mentioned hs-CRP as the only inflammatory marker that can be used for risk prediction both for primary and secondary prevention of cardiovascular events.3 However, very limited information is available about the relationship between various CV risk factors and hs-CRP levels and the significance of elevated hs-CRP in Indian patients, who as compared to the western populations have vast differences in CVD epidemiology. Therefore, this study was sought to assess the relationship between the levels of hs-CRP and clinical profile, CV risk factors and the coronary angiographic findings in Indian patients presenting with acute coronary syndrome (ACS).