C-reactive Protein In Subjects Research Articles

Correlation of C-Reactive Proteins With Chronic Periodontitis. A Prospective Study

Abstract Context: The C-reactive protein (CRP) is an acute-phase reactant protein that is produced in response to various inflammatory and noxious stimuli that include exposure to heat, traumatic conditions, varieties of infectious processes, and conditions of hypoxia. Estimation of CRP levels in serum samples helps in providing important information related to the diagnosis, monitoring, and treatment of inflammatory processes and various associated diseases. Materials and Methods: This prospective longitudinal study was designed to evaluate serum CRPs in subjects who were selected for study participation after fitting into inclusion criteria, which were as follows: a) study participants who were clinically diagnosed with chronic generalized periodontitis along with periodontal pocket depths of ≥5 mm and also radiographic alveolar bone loss; b) subjects within the age range of 35 to 55 years; and c) no smoking habit or use of tobacco in any other form. Results: Patients were assessed for clinical parameters such as gingival index, sulcular bleeding index, mean depth of periodontal pocket, and loss of clinical attachment. Blood was collected at required visits, and CRP was evaluated. Study evaluation periods were baseline (day 0), day 14 (2nd appointment), and day 45 (3rd appointment). Results: Statistically significant reductions in both clinical and serum CRP levels were obtained at subsequent appointments. Conclusion: This study has demonstrated and supported the evidence that serum CRPs act as a biomarker in determining the prognosis of chronic periodontitis patients after nonsurgical periodontal treatment.

Meta-analysis of cytokine and C-reactive protein levels in high-risk psychosis

ObjectiveSchizophrenia is associated with aberrant blood cytokine and C-reactive protein (CRP) levels. However, less is known about alterations in these markers prior to the onset of psychosis. We performed a meta-analysis of blood cytokines and CRP in subjects at high-risk for psychosis. MethodWe identified articles by systematic searches of PubMed, PsycINFO, and Web of Science databases, and the reference lists of identified studies. Eight studies met the inclusion criteria, including seven studies of high-risk psychosis versus controls, and four studies of high-risk subjects who converted to a psychotic disorder versus non-converters. ResultsBlood IL-6 levels were significantly higher (SMD = 0.31, 95% CI 0.02–0.59, p = 0.04) and blood IL-1β levels were significantly lower (SMD = −0.66, 95% CI −1.27 to −0.05, p = 0.05) in subjects at high-risk for psychosis versus controls. Between-study heterogeneity was not significant for either IL-1β or IL-6, and there was no evidence of publication bias. There was a non-significant trend for higher blood IL-12 levels in converters versus non-converters (SMD = 0.86, 95% CI −0.06–1.79, p = 0.07). ConclusionWe found limited evidence for blood cytokine and CRP alterations in subjects at high-risk for psychosis. Our findings should be interpreted with caution in light of a small number of studies, cumulative sample size, and heterogeneity of high-risk criteria, but warrant investigation in larger samples. This includes studies of subjects at high-risk of developing psychosis and controls, as well as the potential of inflammation as a predictor of conversion to psychosis. These findings have important potential implications for our understanding of the pathophysiology of schizophrenia.

Sex Differences in High Sensitivity C-Reactive Protein in Subjects with Risk Factors of Metabolic Syndrome.

BackgroundMetabolic syndrome (MetS) is associated with a higher risk of all-cause mortality. High-sensitivity C-reactive protein (hsCRP) is a prototypic marker of inflammation usually increased in MetS. Women with MetS-related diseases present higher hsCRP levels than men with MetS-related diseases, suggesting sex differences in inflammatory markers. However, it is unclear whether serum hsCRP levels are already increased in men and/or women with MetS risk factors and without overt diseases or under pharmacological treatment.ObjectiveTo determine the impact of the number of MetS risk factors on serum hsCRP levels in women and men.MethodsOne hundred and eighteen subjects (70 men and 48 women; 36 ± 1 years) were divided into four groups according to the number of MetS risk factors: healthy group (CT; no risk factors), MetS ≤ 2, MetS = 3, and MetS ≥ 4. Blood was drawn after 12 hours of fasting for measurement of biochemical variables and hsCRP levels, which were determined by immunoturbidimetric assay.ResultsThe groups with MetS risk factors presented higher serum hsCRP levels when compared with the CT group (p < 0.02). There were no differences in hsCRP levels among groups with MetS risk factors (p > 0.05). The best linear regression model to explain the association between MetS risk factors and hsCRP levels included waist circumference and HDL cholesterol (r = 0.40, p < 0.01). Women with MetS risk factors presented higher hsCRP levels when compared with men (psex < 0.01).ConclusionsDespite the absence of overt diseases and pharmacological treatment, subjects with MetS risk factors already presented increased hsCRP levels, which were significantly higher in women than men at similar conditions.

The impact of obstructive sleep apnea on high-sensitivity C-reactive protein in subjects with or without metabolic syndrome.

It is unclear whether obstructive sleep apnea (OSA) is independently associated with increased levels of the acute-phase reactant C-reactive protein (CRP). The purpose of this study was to evaluate the relationship between OSA and high-sensitivity CRP (hs-CRP) levels according to the presence or absence of metabolic syndrome (MetS). This study recruited 245 male bus drivers from one transportation company in Taiwan. Each participant was evaluated by a polysomnography (PSG) test, blood lipids examination, and hs-CRP. Severity of OSA was categorized according to the apnea-hypopnea index (AHI). Subjects were categorized into severe OSA group (n = 44; 17.9%), moderate and mild OSA group (n = 117; 47.8%), and non-OSA group (n = 84; 34.3%). AHI had a significant association with hs-CRP (β = 0.125, p = 0.009) adjusting for age, smoking, drinking, and MetS status. Hs-CRP was elevated with severe OSA (β = 0.533, p = 0.005) even adjusting for BMI and MetS. Moreover, there was an independent effect for adjusted odds ratios (AORs) between the stratification of the severity for OSA and MetS. Elevated hs-CRP level is associated with severe OSA, independent of known confounders. The effect of OSA in CRP is independent of MetS was identified.

Almond supplementation in the absence of dietary advice significantly reduces C-reactive protein in subjects with type 2 diabetes

Heart disease and stroke are primary causes of morbidity and mortality among people with type 2 diabetes (T2D). The objective of this 12-week randomized, parallel-arm controlled study was to determine if almond supplementation (1.5 oz/d) without further diet instruction improves diabetic and cardiovascular risk markers in individuals with T2D (hemoglobin A1c between 6.5 and 9.0%) who were not taking insulin (n = 10) compared to matched controls who were instructed to maintain their customary diet (n = 11). Subjects in the almond-treated group tended to consume fewer carbohydrates (p = 0.073). There were no significant differences in biomarkers of glucose regulation or oxidative stress; however, the inflammatory biomarker C-reactive protein was significantly reduced in the almond-treated group versus controls (−1.2 vs. +4.33 mg/L, p = 0.029). Daily almond ingestion in the absence of other dietary or physical activity modification is beneficial in reducing inflammation in individuals with T2D. Funding was provided by The Almond Board of California.

Relation Between Self-Reported Physical Activity Level, Fitness, and Cardiometabolic Risk

Physical activity and cardiorespiratory fitness are associated with improved cardiovascular health and reduced all-cause mortality. The relation between self-reported physical activity, objective physical fitness, and the association of each with cardiometabolic risk has not been fully described. We studied 2,800 healthy Brazilian subjects referred for an employer-sponsored health screening. Physical activity level was determined as "low," "moderate," or "high" with the International Physical Activity Questionnaire: Short Form (IPAQ-SF). Fitness was measured as METs achieved on a maximal, symptom-limited, treadmill stress test. Using multivariate linear regression analysis, we calculated age, gender, and smoking-adjusted correlation coefficients among IPAQ-SF, fitness, and cardiometabolic risk factors. Mean age of study participants was 43 ± 9 years; 81% were men, and 43% were highly active. Mean METs achieved was 12 ± 2. IPAQ-SF category and fitness were moderately correlated (r = 0.377). Compared with IPAQ-SF category, fitness was better correlated with cardiometabolic risk factors including anthropomorphic measurements, blood pressure, fasting blood glucose, dyslipidemia, high-sensitivity C-reactive protein, and hepatic steatosis (all p <0.01). Among these, anthropomorphic measurements, blood pressure, high-sensitivity C-reactive protein, and hepatic steatosis had the largest discrepancies in correlation, whereas lipid factors had the least discrepant correlation. When IPAQ-SF and fitness were discordant, poor fitness drove associations with elevated cardiometabolic risk. In conclusion, self-reported physical activity level and directly measured fitness are moderately correlated, and the latter is more strongly associated with a protective cardiovascular risk profile.

Does sucrose intake affect antropometric variables, glycemia, lipemia and C-reactive protein in subjects with type 1 diabetes?: a controlled-trial

BackgroundIt is unclear if the sugar intake may affect metabolic parameters in individuals with type 1 diabetes. Therefore, the purpose of this study was to evaluate the effects of sucrose intake in glycemic, lipemic, anthropometric variables, as well as in C-reactive protein (CRP) levels in these individuals.MethodsThirty-three subjects with type 1 diabetes were evaluated at baseline and 3-months after intervention. Volunteers were randomized into groups: sucrose-free (diet without sucrose) or sucrose-added (foods containing sucrose in composition). Both groups received the same macronutrient composition and used the carbohydrate counting methods. All underwent an interview and anthropometric evaluation. Blood was drawn for glycated haemoglobin, glucose, total cholesterol, HDL, and CRP measurement, and the medical charts were reviewed in all cases.ResultsAt baseline, anthropometric, clinical and laboratory variables did not differ between groups, except for the triglycerides. Although at baseline triglycerides levels were higher in the sucrose-added group (p = 0.01), they did not differ between groups after the intervention (p = 0.92). After 3-months, CRP was higher in the sucrose-added than in the sucrose-free group (p = 0.04), but no further differences were found between the groups, including the insulin requirements, anthropometric variables, body composition, and glycemic control. Both groups showed sugars intake above the recommendations at baseline and after intervention.ConclusionsSucrose intake, along with a disciplined diet, did not affect insulin requirements, anthropometric variables, body composition, lipemic and glycemic control. However, although the sucrose intakes increase CRP levels, the amount of sugar in the diet was not associated with this inflammatory marker.

Does sucrose intake affect antropometric variables, glycemia, lipemia and C-reactive protein in subjects with type 1 diabetes?

Background & aimsDiet based on carbohydrate-counting has been used to achieve the glucose control in diabetes, however, it is unclear if the sucrose intake may affect other metabolic parameters. Therefore, the aim of the study was to determine the effects of sucrose intake on the glycemic, lipemic, anthropometric variables, and C-reactive protein (CRP) in subjects with type 1 diabetes. MethodsThirty-three subjects with type 1 diabetes were evaluated at baseline and 3-months after intervention. Volunteers were randomized into groups: sucrose-free (diet without sucrose) or sucrose-added (foods containing sucrose in composition), both receiving the same macronutrient composition and prescribed by carbohydrate-counting. ResultsAt baseline, anthropometric, clinical and laboratory variables did not differ in both groups, except triglycerides. Although triglycerides were higher in the sucrose-added group (p = 0.01), they did not differ between groups after the intervention (p = 0.92). After 3-months, CRP was higher in sucrose-added than sucrose-free group (p = 0.04), however, Spearman and regression analysis showed no relation with sucrose intake. Furthermore, before and after intervention, both groups showed sugars intake above the recommendations. ConclusionsSucrose intake, along with a disciplined diet, did not affect insulin requirements, anthropometric variables, body composition, and glycemic control, however, increased CRP and may have reduced triglycerides.

Effects of simvastatin and ezetimibe on interleukin-6 and high-sensitivity C-reactive protein

Objectives. Statins decrease cardiovascular events mainly by lowering cholesterol but anti-inflammatory effects also play a role. The effects of the cholesterol absorption inhibitor ezetimibe on markers of inflammation remain unclear. We performed an exploratory post-hoc analysis whether these drugs influence the pro-inflammatory markers interleukin-6 and high-sensitivity C-reactive protein in subjects with very-low cardiovascular risk. Design. Single center, randomized, parallel 3-group study in 72 healthy men without apparent cardiovascular disease (age 32 ± 9 years, BMI 25.7 ± 3.2 kg/m2). Each group of 24 subjects received a 14-day treatment with either simvastatin 40 mg, ezetimibe 10 mg, or their combination. Results. Baseline IL-6 and hsCRP concentrations in the total cohort were 0.72 ± 0.57 ng/l and 0.40 ± 0.65 mg/l, respectively, with no differences between the 3 groups. Median changes (interquartile range) in IL-6 and hsCRP concentrations were −22% (−43 to 0%) and −30% (−44 to +19%) after simvastatin, −5% (−36 to +30%) and +9% (−22 to +107%) after ezetimibe, and +15% (−15 to +86%) and +1 (−30 to +49%) after the combination. Using a generalized linear model, the multivariable adjusted overall P-values for these changes were 0.008 (IL-6) and 0.1 (hsCRP). Conclusions. Simvastatin decreases the pro-inflammatory markers IL-6 and almost significantly hsCRP while ezetimibe monotherapy or the combination with simvastatin has no effect.Trial registration: ClinicalTrials.gov identifier: NCT00317993.

Utilization of a biochemical kit for detection of C-reactive protein (CRP) in the saliva of periodontal disease individuals

Introduction: Periodontal disease (PD) is a chronic inflammatory process that occurs in response to infection from bacteria in dental plaque. PD affects and destroys the periodontal tissues causing teeth loss. It is also associated to systemic diseases. C-reactive protein (CRP) is a protein produced by the liver and released into the blood during the acute phase of inflammation. Therefore, CRP is very used as a marker for inflammation process. Studies on the presence of CRP in the saliva of the subjects with PD do not exist. Objective:The aim of this study was to test a biochemical kit for CRP detection in blood plasma to monitor CRP in saliva of PD subjects. Material and methods: Saliva was collected from 40 individuals, both sexes, from 20-45 years-old, divided into two groups: Test Group – PD subjects (TG; n = 20) and Control Group (CG n = 20), without PD. The following salivary parameters were analysed: buffer capacity (BC), salivary flow (SF), pH, urea, total proteins, and CRP. Results: pH, SF and BC values were considered normal in both groups. The urea concentration was higher in TG (27.4 mg/dl ± 10.03) than CG (22.9 mg/dl ± 8.3). However, the concentration of total proteins was higher in CG (201.2 ± 100 mg/dl) than TG (155.0 ± 95 mg/dl). CRP was detected in 11 PD subjects and in eight subjects without PD. Conclusion: There were no significant differences between the two groups in relation to SF, pH and BC. However, in PD subjects’ saliva, urea values increased and total proteins decreased. The biochemical kit detected CRP in subjects’ saliva of both groups.

Prognostic value of high sensitive C-reactive protein in subjects with silent myocardial ischemia

ObjectivesThe aim of this study was to evaluate the prognostic value of high sensitive C-reactive protein (CRP) in subjects with silent myocardial ischemia (SMI). DesignIn total, 678 healthy men and women aged 55 to 75 years with no history of cardiovascular disease or stroke were included. High-sensitive CRP and 48-hour ambulatory ECG monitoring were performed. The primary endpoint was the combined endpoint of death and myocardial infarction. ResultsThe median follow-up time was 76 months. Seventy-seven subjects (11.4%) had SMI. The combined endpoint occurred in 26% of the subjects with SMI and 14% of the subjects without SMI (P = .005). SMI had a poor prognosis in the group with an elevated CRP ≥3.0 μg/mL (hazard ratio, 3.46; 95% confidence interval, 1.67-7.16; P = .001) compared with the group of subjects with SMI and a low CRP <3.0 μg/mL (hazard ratio, 1.37; 95% confidence interval, 0.63-2.98; P = .54). ConclusionsIn apparently healthy subjects, a low level of CRP <3.0 μg/mL selects a low-risk subgroup, despite the presence of SMI.

Haplotypes in theCRPGene Associated with Increased BMI and Levels of CRP in Subjects with Type 2 Diabetes or Obesity from Southwestern Mexico

Objective. We evaluated the association between four polymorphisms in the CRP gene with circulating levels of C-reactive protein (CRP), type 2 diabetes (T2D), obesity, and risk score of coronary heart disease. Methods. We studied 402 individuals and classified them into four groups: healthy, obese, T2D obese, and T2D without obesity, from Guerrero, Southwestern Mexico. Blood levels of CRP, glucose, cholesterol, triglycerides, and leukocytes were measured. Genotyping was performed by PCR/RFLP, and the risk score for coronary heart disease was determined by the Framingham's methodology. Results. The TT genotype of SNP rs1130864 was associated with increased body mass index and T2D patients with obesity. We found that the haplotype 2 (TGAG) was associated with increased levels of CRP (β = 0.3; 95%CI: 0.1, 0.5; P = 0.005) and haplotype 7 (TGGG) with higher body mass index (BMI) (β = 0.2; 95%CI: 0.1, 0.3; P < 0.001). The risk score for coronary heart disease was associated with increased levels of CRP, but not with any polymorphism or haplotype. Conclusions. The association between the TT genotype of SNP rs1130864 with obesity and the haplotype 7 with BMI may explain how obesity and genetic predisposition increase the risk of diseases such as T2D in the population of Southwestern Mexico.

Magnesium (Mg) supplementation improves magnesium status and decreases elevated C‐reactive protein in adults older than 51 years with poor quality sleep

NHANES data indicate that two‐thirds of U.S. adults consume less than the RDA for Mg. A low Mg intake or status has been associated with poor quality sleep and inflammatory stress. Thus, 100 adults (22 males and 78 females) older than 51 yr with a Pittsburgh Sleep Quality Index (PSQI) higher than 5 were randomly assigned to 2 groups matched by gender, age, and overall PSQI score. After baseline assessment (wk 1), one group was given a 300 mg/d Mg supplement as Mg citrate, and the other a sodium citrate placebo, for 7 wk. Final assessments were made 5 and 7 wk after supplement initiation for 96 subjects that completed the study as designed. PSQI improved (10.4 to 6.6, p&lt;0.0001) and erythrocyte Mg increased (4.75 to 5.05 pg/cell) regardless of Mg or placebo supplementation. The erythrocyte Mg increase was ~70% greater with Mg supplementation (4.72 to 5.15 vs. 4.78 to 4.94 pg/cell). Mg supplementation reduced plasma C‐reactive protein in subjects with baseline values &gt;3.0 mg/dL; these subjects also had a higher body mass index. Baseline serum Mg was below normal (&lt;1.8 mg/dL) in 37 subjects. Analysis of these subjects found that serum Mg and calcium (Ca) were significantly increased with the increases more marked with Mg‐supplementation (Ca, 8.36 to 8.74 vs. 8.43 to 8.52 mg/dL; Mg 1.69 to 1.82 vs. 1.69 to 1.73 mg/dL). Findings indicate that Mg status of many older individuals could be improved. (Supported by Tyrase Research, Grand Forks, ND)

Effect of atorvastatin on circulating hsCRP concentrations: A sub-study of the Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) study

Background Elevated C-reactive protein (CRP) concentration is a risk factor for cardiovascular events that may add prognostic information. Statin treatment is associated with significant reductions in CRP concentrations, which appear to be unrelated to the magnitude of LDL-cholesterol reduction. We investigated the effect of atorvastatin, across its dose range, on high sensitivity (hs)CRP in subjects at high cardiovascular risk. Methods ACTFAST was a 12 week, prospective, multicenter, open-label trial in which high-risk subjects were assigned a starting dose of atorvastatin (10, 20, 40 or 80 mg/d) based on LDL-C and status of statin use at screening (1345 statin-free [SF] and 772 previously statin-treated [ST]). Results At baseline, ST subjects had significantly lower hsCRP levels than SF subjects (ST group 2.31, 95% CI 2.15, 2.48 mg/L vs. SF group 3.16, 95% CI 2.98, 3.34 mg/L, p < 0.05). In the SF group, atorvastatin 10 to 80 mg significantly ( p < 0.01) reduced hsCRP levels in a dose dependent-manner. In ST group, additional hsCRP reductions were observed over the statin used at baseline, which were not dose-dependent. Atorvastatin significantly decreased hsCRP concentrations in subjects with or without diabetes or the metabolic syndrome. Conclusions Atorvastatin treatment at different doses, particularly 80 mg, significantly reduced hsCRP serum concentrations. This reduction was observed in both SF and ST groups and was independent of the presence of metabolic syndrome and/or diabetes. The beneficial effect of atorvastatin was evident at 6 weeks, supporting the practice of early introduction of higher doses of atorvastatin in high-risk patients.

Effect of intensive lifestyle intervention on C-reactive protein in subjects with impaired glucose tolerance and obesity. Results from a randomized controlled trial with 5-year follow-up

C-reactive protein (CRP) is a marker of metabolic and cardiovascular disease. To study the effects of lifestyle on CRP in a high-risk population we conducted a randomized controlled trial on 200 obese subjects (BMI > 27 kg m−2) with impaired glucose tolerance recruited from primary care settings. They were randomized to either a 1-month stay at a wellness centre focusing on diet, exercise and stress management (intervention group) or 30–60 min of oral and written information on lifestyle intervention (control group). A significant reduction of CRP was observed after 1 month and 1 year in the intervention group. They reduced their CRP levels more than the control group 1 year after intervention (p=0.004). In conclusion lifestyle intervention can decrease CRP in obese individuals with impaired glucose tolerance for up to 1 year. Further research is needed to evaluate whether the CRP level reduction translates into a decreased risk for cardiovascular morbidity.

High-sensitivity C-reactive protein in subjects with type 2 diabetes mellitus and/or high blood pressure

Type 2 diabetes mellitus (DM2) and high blood pressure (HBP) may contribute to the development of cardiovascular disease, and inflammation may be an important factor in these diseases. In the present study, plasma levels of high-sensitivity C-reactive protein (hs-CRP) were measured in subjects with DM2 and/or HBP and compared to those of normal subjects. Eighty-nine subjects were analyzed for hs-CRP, including 13 normotensive patients with DM2, 17 patients with HBP, 34 hypertensive patients with DM2 (DM2+HBP) and 25 normal subjects. The plasma hs-CRP levels were significantly lower in the controls than in the HBP+DM2 group (p < 0.05). DM2 associated with HBP was also correlated with increased plasma hs-CRP levels (n = 89, r = 0.25, p = 0.0162). Only hypertensive patients with DM2 had higher levels of hs-CRP, a circulating inflammatory marker, than normal subjects. This finding suggests that patients with two associated diseases have a more active inflammatory state.

Widespread vascular production of C-reactive protein (CRP) and a relationship between serum CRP, plaque CRP and intimal hypertrophy

Objectives Evidence of local vascular production and a relationship between serum hsCRP levels and tissue expression of CRP in subjects with vascular disease would support a direct role for CRP in atherosclerosis. Methods and results Vascular tissue from subjects undergoing coronary artery bypass grafting surgery (CABGS) ( n = 28) and carotid endarterectomy (CEA) ( n = 25) were studied. Histological samples were assessed for intima–media ratio (IMR) and CRP by immunohistochemistry. CRP mRNA was quantified by real-time polymerase chain reaction. CRP mRNA was seen in all plaques, non-atherosclerotic artery and atrium but no difference in mRNA expression was seen between plaque and non-atherosclerotic tissue. Serum hsCRP correlated with IMR ( r = 0.64, p = 0.001) in non-atherosclerotic arteries and with plaque CRP staining ( r = 0.57, p = 0.009) independent of age, BMI, lipids, diabetes and blood pressure. In a separate patient series, serum hsCRP was measured in aortic and coronary sinus blood from subjects undergoing CABGS or angiography ( n = 54). There was a coronary circulation hsCRP gradient ([mean ± S.E.M.] aortic CRP 4.3 mg/l ± 0.8 versus coronary sinus 5.8 ± 1.2 mg/l, p < 0.05). Conclusions Widespread vascular CRP mRNA expression, a correlation between serum hsCRP, intimal hypertrophy and plaque CRP, and a coronary hsCRP gradient suggest vascular secretion may contribute to serum CRP levels.

Reply from the Authors

We are very grateful to Dr. Nzerue for his thoughtful comments on our paper1.Liangpunsakul S. Chalasani N. Relationship between hepatitis C and microalbuminuria: Results from the NHANES III.Kidney Int. 2005; 67: 285-290Google Scholar. In this correspondence, we respond to thoughtful queries by Dr. Nzerue. First, in our discussion, we admitted that a single measurement of urine albumin to creatinine ratio to assess for the presence of microalbuminuria is not ideal. Unfortunately, the NHANES III is a cross-sectional study and sequential urinary data were not available. Second, Dr. Nzerue points out that there is not a consistent relationship between the metabolic syndrome and microalbuminuria in some age groups, and this may explain why we failed to observe an association between hepatitis C and the metabolic syndrome. While this is plausible, more rigorous studies are needed to examine this issue as our results disagree with a previous retrospective cohort study2.Sanyal A.J. Contos M.J. Sterling R.K. et al.Nonalcoholic fatty liver disease in patients with hepatitis C is associated with features of the metabolic syndrome.Am J Gastroenterol. 2003; 98: 2064-2071Google Scholar, which showed a high prevalence of the metabolic syndrome in patients with hepatitis C. Third, we accept the possibility that chronic inflammation or immune processes are involved in the pathogenesis of microalbuminuria in hepatitis C subjects. We explored this possibility, but found that cryoglobulin levels were not measured in the NHANES III, and rheumatoid factor data were missing in most patients in the hepatitis C cohort. However, we failed to find any differences in the levels of C-reactive protein in subjects with hepatitis C and controls (0.41 ± 0.62 vs. 0.44 ± 0.86 mg/dL, P = 0.5). Our study should be viewed as exploratory in nature and our observations require validation in ongoing prospective studies (e.g., NIDDK-funded Virahep-C study).

The association between cardiorespiratory fitness and C-reactive protein in subjects with the metabolic syndrome

Despite recent improvements in tackling road safety challenges, particularly in developed countries, road traffic crashes account for 1.35 million deaths annually and cost over 65 us$ billion. This paper reviews the existing socio-economic costs literature, highlights research gaps, and draws attention to the lack of analysis in developing countries, which account for 90% of the fatalities. We rely on both simple descriptive analyses and formal econometric analyses. Our descriptive results show an upward trend over the recent years, mostly in high and middle-income countries. The paper focuses on the differences in estimating the socio-economic costs of road traffic crashes using two popular methodologies, the willingness-to-pay (wtp) and the human capital (hc). Our econometric analysis shows that papers that use wtp tend to compute the impact as a percentage of gdp that is on average ̃1% higher than those that use the hc approach. Likewise, studies using the human capital method tend to underestimate the total socio-economic costs by a factor of two compared to the cost derived from the wtp approach; this gap then reduces substantially when accounting for population density, countries' income levels, and road safety outcomes. Further, the paper stresses the underreporting problem and the inexistence of a mechanism to reasonably account for it in socio-economic costs calculations. The paper concludes by advocating for more studies focusing on low and middle-income countries using a combination of common approaches with other valuation methods.

Prediction of Heart Failure by Amino Terminal-pro–B-Type Natriuretic Peptide and C-Reactive Protein in Subjects With Cerebrovascular Disease

B-type natriuretic peptide (BNP) and C-reactive protein (CRP) are elevated in persons at risk for congestive heart failure (CHF). However, limited data are available directly comparing BNP-related peptides and CRP in persons at risk of CHF. To evaluate amino terminal-pro-BNP (NT-proBNP) and CRP, separately and together, for assessment of risk of CHF, we performed a nested case-control study of the 6105 participants of the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS), a placebo-controlled study of a perindopril-based blood pressure-lowering regimen among individuals with previous stroke or transient ischemic attack (TIA). Each of 258 subjects who developed CHF resulting in death, hospitalization, or withdrawal of randomized therapy during a mean follow-up of 3.9 years was matched to 1 to 3 control subjects. NT-proBNP and CRP predicted CHF; the odds ratio for subjects in the highest compared with the lowest quarter was 4.5 (95% confidence interval, 2.7 to 7.5) for NT-proBNP and 2.9 (confidence interval, 1.9 to 4.7) for CRP, and each remained a predictor of CHF after adjustment for all other predictors. Screening for both markers provided better prognostic information than screening for either alone. Elevation of NT-proBNP above 50 pmol/L and CRP above 0.84 mg/L predicted CHF with sensitivity of 64% and specificity of 66%. NT-proBNP and CRP predicted CHF in subjects receiving perindopril-based therapy. We conclude that NT-proBNP and CRP are independent predictors of CHF risk after stroke or TIA. Moreover, NT-proBNP and CRP may be markers of mechanisms of CHF pathogenesis distinct from those responsive to angiotensin-converting enzyme inhibitor-based therapy.