Differences In C-reactive Protein Levels Research Articles

Study of genetic, metabolic and inflammatory risk factors in patients of acute ischemic stroke

Stroke is the third leading cause of death and foremost cause of disability. Based on studies in CAD patients, a focus has been shifted on genetic and inflammatory markers as risk factors for stroke besides deranged lipid profile. The present study was aimed to ascertain the role of Lipoprotein (a), C-Reactive protein (CRP) levels and lipids in patients of ischemic stroke. The study was done in 82 subjects including 40 Computerized Tomography (CT) proven patients of ischemic stroke and 42 age and sex matched controls. Complete biochemical parameters including lipid profile were carried out on autoanalyzer using standard kits and reagents. Lipoprotein (a) [Lp(a)] was determined by immunoturbidimetric assay. Atherogenic indices (Total cholesterol/ HDL, LDL/HDL and Lipid Tetrad Index) were calculated using these lipid parameters. The CRP levels were measured semi-quantitatively by latex agglutination test method. Out of 40 stroke patients, 38 had abnormalities in lipid profile (As per ATP III guidelines). A significant difference was seen in serum cholesterol, LDL cholesterol and atherogenic indices between the patients and controls. The difference in CRP levels in cases and control subjects was highly significant (4.78±0.72 mg/dl vs 0.76 ±0.70, p<0.001). 96.5% of patients with raised CRP had abnormal lipid levels also. CRP levels in stroke patients showed significant correlation with total cholesterol and LDL (p<0.001), Lp (a) (p=0.002) and atherogenic indices (p<0.05). Raised CRP levels in stroke patients were significantly associated with large territory infarcts, severe disability and poor functional outcome (p<0.05).Genetic [Lp(a)], metabolic (deranged Lipid profile) and inflammatory factors (CRP) together are instrumental in causing cerebrovascular arteriosclerosis leading to ischaemic stroke and can be used as important markers to identify patients at risk of severe stroke and to institute aggressive preventive strategies.

An open label study to determine the effects of an oral proteolytic enzyme system on whey protein concentrate metabolism in healthy males

BackgroundCurrent research suggests that protein intake of 1.5 – 2.8 g/kg/day (3.5 times the current recommended daily allowance) is effective and safe for individuals trying to increase or maintain lean muscle mass. To achieve these levels of daily protein consumption, supplementing the diet with processed whey protein concentrate (WPC) in liquid form has become a popular choice for many people. Some products have a suggested serving size as high as 50 g of protein. However, due to possible inhibition of endogenous digestive enzymes from over-processing and rapid small intestine transit time, the average amount of liquid WPC that is absorbed may be only 15 g. The combined effect of these factors may contribute to incomplete digestion, thereby limiting the absorption rate of protein before it reaches the ceacum and is eliminated as waste. The purpose of this study was to determine if Aminogen®, a patented blend of digestive proteases from Aspergillus niger and Aspergillus oryzae, would significantly increase the in-vivo absorption rate of processed WPC over control values. It also investigated if any increase would be sufficient to significantly alter nitrogen (N2) balance and C-reactive protein (CRP) levels over control values as further evidence of increased WPC absorption rate.MethodsTwo groups of healthy male subjects were assigned a specified balanced diet before and after each of two legs of the study. Subjects served as their own controls. In the first leg each control group (CG) was dosed with 50 g of WPC following an overnight fast. Nine days later each test group (TG) was dosed following an overnight fast with 50 g of WPC containing either 2.5 g (A2.5) or 5 g (A5) of Aminogen®. Blood samples were collected during each leg at 0 hr, 0.5 hr, 1 hr, 2 hr, 3 hr, 3.5 hr and 4 hr for amino acid (AA) and CRP analyses. The following 18 AAs were quantified: alanine, arginine, aspartic acid, cysteine, glutamic acid, glycine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine and valine. Urine was collected for 24 hours from 0 hr for total N2 analysis. Results are expressed as means ± SEM. All significance and power testing on results was done at a level of alpha = 0.05. Area under the concentration time curve (AUC) was calculated using the trapezoidal rule. One-way analysis of variance (ANOVA-1) was done between CGs, between TGs and between time points. One-way repeated measures analysis of variance (ANOVA-1-RM) was done to compare CGs and TGs. Two-way analysis of variance (ANOVA-2) was performed on total serum amino acid (TSAA) levels, urine N2 levels and CRP levels between each CG and TG.ResultsAfter baseline subtraction the mean AUC was significantly (p ≤ 0.05) greater in each TG compared the corresponding CG. Comparison of the mean AUC between each TG and each CG was not significantly different. Total serum amino acid (TSAA) levels were significantly greater in each TG compared the corresponding CG. They were also significantly different between each TG but not between each CG. All individual serum amino acid (ISAA) levels in TG-A2.5 except glycine, histidine, methionine and serine were significantly higher than in CG-A2.5 at 4 hr. All ISAA levels in TG-A5 except methionine and serine were significantly higher than in CG-A5 at 4 hr. The N2 balance was significantly higher in each TG compared to the corresponding CG, but not significantly different between each CG and between each TG. Significant differences in CRP levels are reported between each TG compared to the corresponding CG, but not significantly different between each TG and between each CG.ConclusionA patented blend of digestive proteases (Aminogen®) increased the absorption rate of processed WPC over controls, as measured by statistically significant increases in AUC, TSAA levels, ISAA levels and N2 balance. Significant decreases in CRP levels and fluxes in AA levels are also reported.

Racial differences in C-reactive protein levels during normal pregnancy

Racial differences in C-reactive protein levels during normal pregnancy

When do social inequalities in C-reactive protein start? A life course perspective from conception to adulthood in the Cardiovascular Risk in Young Finns Study

It is unclear when in the life course do social inequalities in inflammation emerge. We examined whether the association between socioeconomic position (SEP) and C-reactive protein (CRP) is determined at conception, in childhood, adolescence or adulthood in 1484 participants from the population-based Cardiovascular Risk in Young Finns Study. Five variants of the CRP gene were used to investigate whether SEP differences in CRP levels are determined at conception. SEP and serum CRP were assessed in childhood (age 3-9), adolescence (age 12-18) and in adulthood (age 24-39). SEP was measured using parental education and occupational status in childhood and adolescence, and participants' own education and occupational status in adulthood. Participants with CRP > 10 mg/l were excluded. All CRP gene variants were associated with circulating CRP concentrations in childhood, but there were no differences in the distribution of these variants by SEP. No strong evidence was found of associations between parental SEP and CRP. A graded association between higher SEP and lower CRP was observed in adulthood for education (P = 0.0005) but not for occupational status. Trajectories that led to high educational achievement both in the participants and their parents were associated with lower (P <or= 0.047) CRP levels in adulthood. Excluding participants with infectious diseases, pregnant or lactating women and women using oral contraceptives did not change the findings. In this cohort, SEP differences in CRP concentrations seen in adulthood appear not to be determined at conception or evident in childhood or adolescence.

C reactive protein and its determinants in healthy men and women from European regions at different risk of coronary disease: the IMMIDIET Project.

Differences in C-reactive protein (CRP) levels and its determinants in three European populations at different risk of coronary artery disease (CAD) were studied. Subjects were recruited randomly in Limburg (Belgium), Abruzzo (Italy) and south-west (SW) London (England). Ten-year risk of fatal coronary events (estimated using risk equations provided by the SCORE Project) was lower both in men and women from Abruzzo, intermediate in people from Limburg and higher in subjects from SW London. Within each country, high sensitivity (hs)-CRP levels were higher in the high-risk class in men but not in women. Men from Abruzzo had higher hs-CRP levels than those from Limburg and SW London. Women always had higher hs-CRP levels than men. The strongest hs-CRP determinant was body mass index (BMI, R(2) = 0.14) in women and waist circumference (WC, R(2) = 0.046) in men. The highest hs-CRP levels were observed in subjects with both high BMI and high WC. Metabolic syndrome was associated with high levels of CRP both in men and women, even after adjustment for confounders. Difference in CRP levels cannot explain the European gradient of CVD risk, although CRP levels are associated with the calculated SCORE risk of fatal coronary events within each country.

Systemic Inflammation and Repair of Abdominal Aortic Aneurysm

Inflammation is integral to the pathogenesis of abdominal aortic aneurysm (AAA). This study examines preoperative biomarkers of systemic inflammation in patients undergoing open repair of intact and ruptured AAA. One-hundred twelve patients were entered into a prospective observational study. Preoperative POSSUM physiology score, C-reactive protein (CRP), white blood count (WBC), platelet count, fibrinogen, and albumin were recorded and related to clinical variables using univariate analysis. Sixty-one patients with a ruptured AAA, 39 with an asymptomatic intact AAA, and 12 with an acutely symptomatic intact AAA underwent attempted repair. There were two inflammatory asymptomatic aneurysms and one inflammatory ruptured aneurysm. No patient had clinical evidence of coexistent inflammatory disease. Patients with a symptomatic intact AAA had a significantly greater level of CRP and fibrinogen, higher WBC, and lower serum albumin, than those with an asymptomatic intact AAA. Patients with a ruptured aneurysm had a significantly greater level of CRP, higher WBC, and lower serum albumin than those with an asymptomatic intact aneurysm. Patients with a symptomatic intact AAA had a significantly higher CRP level, but lower WBC, than those with a ruptured AAA. There was no difference in CRP level, WBC, or serum albumin between survivors and non-survivors of attempted repair of asymptomatic, symptomatic and ruptured AAA. Acutely symptomatic and ruptured AAAs are associated with an early elevation in systemic inflammatory biomarkers. This early activation of the inflammatory response might influence perioperative outcome.

Distributions of C-Reactive Protein and its Association With Metabolic Syndrome in Middle-Aged and Older Chinese People

We evaluated the distributions of C-reactive protein (CRP) and its association with metabolic syndrome (MetS) in middle-aged and older Chinese people. Several studies have suggested that CRP is a risk factor of MetS. However, it remains unclear how CRP levels are distributed and whether they are associated with MetS in Chinese people. We conducted a population-based cross-sectional survey in 2005 in Beijing and Shanghai, with a total of 1,458 men and 1,831 women age 50 to 70 years. Metabolic syndrome was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. The median CRP level was 0.68 mg/l among the study population. The CRP levels were significantly higher among participants from Beijing or from urban areas than those in participants from Shanghai or from rural areas (p < 0.01). No gender difference in CRP levels was observed. The prevalence of MetS progressively increased with elevated CRP levels (p < 0.0001 for trend). In the highest quartile of CRP levels (>1.50 mg/l), the risk for MetS was substantially higher (odds ratio 5.97; 95% confidence interval 4.75 to 7.51) compared with that in the lowest quartile of CRP levels (< or =0.33 mg/l) after adjustment for age, gender, geographic location, lifestyle factors, educational attainment, and family history of chronic diseases. This association was observed in both obese and nonobese participants. The overall plasma level of CRP is low but highly associated with the MetS among the middle-aged and elderly Chinese population. Prospective studies are needed to investigate the role of CRP in the development of MetS and related chronic diseases among Chinese people.

Lab‐on‐a‐Chip Methods for Point‐of‐Care Measurements of Salivary Biomarkers of Periodontitis

Salivary secretions contain a variety of molecules that reflect important pathophysiological activities. Quantitative changes of specific salivary biomarkers could have significance in the diagnosis and management of both oral and systemic diseases. Modern point-of-care technologies with enhanced detection capabilities are needed to implement a significant advancement in salivary diagnostics. One such promising technology is the recently described lab-on-a-chip (LOC) assay system, in which assays are performed on chemically sensitized beads populated into etched silicon wafers with embedded fluid handling and optical detection capabilities. Using this LOC system, complex assays can be performed with small sample volumes, short analysis times, and markedly reduced reagent costs. This report describes the use of LOC methodologies to assess the levels of interleukin-1beta (IL-1beta), C-reactive protein (CRP), and matrix metalloproteinase-8 (MMP-8) in whole saliva, and the potential use of these biomarkers for diagnosing and categorizing the severity and extent of periodontitis. This study demonstrates that the results achieved by the LOC approach are in agreement with those acquired with standard enzyme-linked immunosorbent assay (ELISA), with significant IL-1beta and MMP-8 elevations in whole saliva of periodontitis patients. Furthermore, because of the superior detection capacities associated with the LOC approach, unlike those with ELISA, significant differences in CRP levels between periodontitis patients and normal subjects are observed. Finally, principal component analysis (PCA) is performed to yield an efficient method to discriminate between periodontally healthy and unhealthy patients, thus increasing the diagnostic value of these biomarkers for periodontitis when examined with the integrated LOC sensor system.

Abstract 4189: Gender Difference in Inflammatory Markers: What is the Contribution of Visceral Adiposity?

Several studies have reported a gender difference in inflammatory markers associated with obesity. Indeed, whereas C-reactive protein (CRP) concentrations have been found to be higher in pre-menopausal women compared to men, interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels have been found to be lower in women than in men because of the inhibitory effect of estrogens on the expression of inflammatory genes. Since body fat distribution is very different between men and pre-menopausal women, the contribution of visceral adipose tissue (VAT) to the gender difference in inflammatory markers is a question of clinical relevance. To examine this issue, plasma CRP, IL-6 and TNF-α levels were measured in a sample of 195 healthy men (age: 41.7±14.9 years) and 139 healthy women (age: 36.6±11.2 years). Pre-menopausal women were characterized by lower plasma TNF-α levels (1.57±0.59 pg/mL vs.1.85±0.99 pg/mL, p=0.001) and higher CRP concentrations (1.91±1.77 mg/L vs. 1.65±1.78 mg/L, p=0.04) than men whereas the IL-6 levels did not differ between genders. Significant positive relationships were observed between VAT accumulation and CRP concentrations in men (r=0.43, p&lt;0.0001) and in women (r=0.42, p&lt;0.0001), or IL-6 in men (r=0.42, p&lt;0.0001) and in women (r=0.51, p&lt;0.0001). Regression analyses showed that gender did affect the associations between VAT and CRP. In order to investigate the contribution of visceral adiposity to the gender variation in inflammatory markers, 85 men and 85 pre-menopausal women were individually matched on the basis of similar VAT accumulation. After such matching procedure, women still had significantly higher CRP levels than men (2.07±1.88 and 1.57±1.84 mg/L, p=.01) whereas no differences were observed in IL-6 and TNF-α concentrations. Thus, these results suggest that the gender difference in CRP levels is not entirely explained by the greater amount of VAT generally observed in men.

Response to Letter by Topakian et al

Response: I am pleased with the interest shown by Topakian et al on our recent study,1 and I am also sure they are very interested in the field of biomarkers and the possibility of using those to guide stroke thrombolysis and not just in setting up “a relationship” with Vall d’Hebron Stroke Unit by exchanging monthly letters through Stroke .2,3 Affairs apart, they raise some very interesting points. They suggest that some treatments such as statins might be influencing C-reactive protein (CRP) level. However, we did this analysis and no differences in CRP level existed regarding pretreatment with statins. In fact, around 20% of our patients were on statins before stroke and those had similar CRP levels than the ones who were not taking statins (0.57 mg/dL [0.22 to 0.88] versus 0.59 mg/dL [0.22 to 0.91], P =0.99). It is possible that the anti-inflammatory effect reported for several statins is abrogated in the acute phase of a vascular event. In fact, in a pilot study conducted by our group using statins in the acute phase of ischemic stroke, we were not able to show a decrease in CRP levels measured at several time-points after …

Gender and C-reactive protein: Data from the Multiethnic Study of Atherosclerosis (MESA) cohort

American Heart Association/Centers for Disease Control and Prevention guidelines support the measurement of C-reactive protein (CRP) to further risk stratify individuals at intermediate risk (10%-20% 10-year risk) for heart disease. Determining gender-specific differences in CRP may alter how CRP levels are interpreted and used to determine risk. MESA is a prospective cohort consisting of 6814 men and women aged 45 to 84 years recruited from 6 US communities. Nonparametric analyses were performed to determine differences in CRP levels by gender in the entire cohort and after stratifying by use of estrogen medication (n = 944). Stratifying by median body mass index (BMI) and generalized linear models were also used to account for confounding variables associated with CRP. Overall, women had substantially higher median CRP levels compared with men (2.56 vs 1.43 mg/L, P < .0001). After excluding women using estrogen and individuals with CRP >10 mg/L, median CRP levels remained higher in women compared with men (1.85 vs 1.33 mg/L, P < .0001). When participants were stratified into high and low BMI groups, the gender difference in CRP levels remained. This pattern of higher CRP levels in women was consistent across all ethnic subgroups even after multivariable adjustment. C-reactive protein levels were higher in women compared with men despite accounting for BMI and other common confounding variables. This gender difference was maintained across all ethnic subgroups. These results suggest that evaluation of gender-specific CRP cut points to determine cardiovascular risk should be considered.

C-Reactive Protein Levels and Atrial Fibrillation After Cardiac Surgery in Women

The aim of this study was to evaluate whether risk for postoperative atrial fibrillation in women is related to preexisting inflammation as detected by plasma C-reactive protein (CRP) concentrations. We further sought to assess the importance of atrial fibrillation for outcome after cardiac surgery in women. The CRP was measured before coronary artery bypass grafting and (or) valvular surgery using cardiopulmonary bypass in 141 women. Univariate and multivariate analyses were used to evaluate for differences in CRP levels between women with and without atrial fibrillation, and to assess for the importance of the arrhythmia and postoperative outcomes. Atrial fibrillation developed in 46 (33%) women. Neither CRP concentrations (median +/- standard error, 13.3 +/- 2.5 mg/L vs 11.7 +/- 1.4 mg/L, p = 0.847), nor the frequency of elevated levels (defined as > upper 95% confidence interval or >19.2 mg/L) (19% vs 21%, p = 0.807) differed between women with or without atrial fibrillation. Patient age and previous stroke, but not CRP levels, were independently associated with atrial fibrillation. Women with atrial fibrillation were more likely to have low cardiac output syndrome (p = 0.018), stroke (p = 0.031), longer duration of hospitalization in the intensive care unit (p = 0.012) and on the postoperative (p = 0.0008) ward, and they were more likely to require an extended care facility after surgery (p = 0.046). In contrast to findings from studies that have included mostly men, preoperative CRP concentrations are not associated with risk for atrial fibrillation after cardiac surgery for women. Postoperative atrial fibrillation in women is associated with increased risk for stroke, longer hospitalization, and extended care facility admission.

C-Reactive Protein in Lone Atrial Fibrillation

An inflammatory cause of atrial fibrillation (AF) has been proposed on the basis of the presence of lymphocytic infiltrates in the biopsy results of patients with lone AF, alterations of C-reactive protein (CRP) and interleukin-6 levels in subjects with AF, and the time course of postoperative AF. Many previous studies exploring inflammatory factors in AF have been confounded by concomitant medical illnesses. Subjects with lone AF provide a unique opportunity to eliminate the effects of associated conditions. We therefore sought to determine CRP levels in homogenous cohorts of patients with lone AF or AF and hypertension. One hundred twenty-one subjects with lone AF, 52 subjects with AF and hypertension, and 75 control subjects were enrolled and studied. Plasma CRP levels were determined using a commercially available immunoassay. There was no significant difference in CRP levels between subjects with lone AF and controls (1.34 vs 1.21 mg/L, p = 0.18). CRP levels in subjects with AF and hypertension were elevated compared with those of controls and those of subjects with lone AF, although this difference was attributable to increased body mass indexes. CRP levels were not elevated in subjects with lone AF compared with controls. In conclusion, these findings clarify previous observations of elevations in CRP levels in subjects with AF and suggest that this marker of systemic inflammation is associated not with the arrhythmia per se, but rather with underlying cardiovascular disease.

Novel anti-inflammatory drugs in hypertension

Over the last years chronic low-grade inflammation has emerged as an important new cardiovascular risk factor. Inflammatory responses within the vasculature might release pro-inflammatory cytokines that increase levels of C-reactive protein (CRP). First evidence for a role of inflammation in the development of atherosclerosis comes from studies demonstrating its prognostic value in unstable angina [1]. The inflammation hypothesis was further supported by data from observational studies demonstrating that CRP is a predictor of first cardiovascular events and might be an even stronger prognostic factor than low-density lipoprotein (LDL)-Cholesterol for coronary artery disease [2,3]. CRP appears to be a stable analyte over time and has been subject to numerous recent studies. Thus, on the basis of several studies, the Centers for Disease Control and Prevention and the American Heart Association recommended using highly sensitive (hs)-CRP and implicated the relative risk categories (low, average, high), corresponding to approximate tertiles of values ( 3.0mg/l, respectively) for individual cardiovascular risk assessment, in particular for those patients presenting with an intermediate risk [4]. However, a single inflammatory marker may or may not estimate all aspects of the underlying inflammatory processes, especially as they may affect cardiovascular disease (CVD) risk, and different markers may differ in their specificity for CVD. Indeed, there are several additional markers with a potential role as useful predictors of cardiovascular risk, such as serum amyloid-A, cytokines (e.g. interleukin (IL)-6), acute phase reactants, adhesion molecules and fibrinogen. Interestingly, a recent publication demonstrated that significant gender and race differences in CRP levels exist which contribute to differences in cardiovascular outcome [5]. CRP plasma levels were assessed in 2749 white and black subjects aged 30–65 years and participating in the Dallas Heart Study. Black subjects had higher CRP levels than white subjects and women had higher CRP levels than men, suggesting that overall recommendations for CRP cut-off levels for risk assessment should be adjusted for race and gender. The clinical relevance of CRP as a significant predictor of coronary artery disease (CAD) was further challenged by Danesh et al. [6], demonstrating that CRP was a weaker marker than traditional risk factors like total cholesterol or smoking in the Reykjavik prospective study. However, in the study population, total plasma cholesterol levels were higher and CRP levels lower than those reported in the US population.

Body Mass Index and C-Reactive Protein in the Healthy Korean Aged Men

The purpose of this study was to determine the relationship between plasma C-reactive protein (CRP) and body mass index (BMI) in elderly Korean men. A review of routine health examination records were done. Out of 671 eligible elderly men, who had their routine health examination in 2001 at a Health Promotion Center of a university hospital, 367 subjects were included after excluding inflammatory conditions. Subgroup analyses were performed on those who did not smoke and exercised regularly. Body composition, blood pressure, blood samples and radiologic examinations including chest radiography and abdominal ultrasound were obtained from each subject. Age, BMI, current smoking, regular exercise, WBC count, HDL-cholesterol, gamma glutamyl transferase were independently associated with logCRP. BMI subgroups according to the Asia-Pacific guideline did not show any difference in CRP level from each other by ANCOVA (p>0.05). However, BMI groups subdivided according to our criteria showed an association with CRP; the CRP level was lowest in the group of BMI between 18.5-19.4 and showed significant difference from BMI group of the highest BMI group (≥29.0). Since elevated CRP levels are associated with higher risk for cardiovascular disease, lower BMI (18.5-19.4) levels may be advised for healthy elderly men in Korea.

The Relationship Between Blood Pressure and C-Reactive Protein in the Multi-Ethnic Study of Atherosclerosis (MESA)

The goal of this study was to determine the relationship between resting blood pressure (BP) and C-reactive protein (CRP) in a multi-ethnic cohort of men and women from the Multi-Ethnic Study of Atherosclerosis (MESA). Several investigators have observed elevated levels of CRP in individuals with hypertension. Hypertension prevalence varies considerably across ethnic groups. Important questions remain regarding whether the relationship between hypertension and CRP is similar across ethnic and gender subgroups. The MESA participants had CRP levels determined at the baseline clinical examination (N = 6,814). Hypertension, treated as a dichotomous variable (yes/no), was defined as a systolic or diastolic BP > or =140/90 mm Hg or a self-reported history of hypertension and use of antihypertensive medications. The geometric mean CRP in hypertensive participants was 2.3 +/- 0.07 mg/l compared with 1.6 +/- 0.07 mg/l among normotensive participants (p < 0.0001). The relative difference in CRP levels in hypertensives compared with normotensives was similar regardless of gender (13% in men and 13% in women). Ethnic comparisons showed that Chinese participants had the lowest CRP concentration but the largest difference in CRP by hypertension status (24%). Caucasians and African Americans had 10% to 15% higher CRP levels with hypertension, whereas Hispanics had no significant difference in CRP by hypertension status. This study confirms the existence of an independent association between hypertension and inflammation in both men and women. Ethnic group differences were evident, with the strongest association observed in Chinese participants and no difference in CRP levels by hypertension status in Hispanics.

Association of C-Reactive Protein With Blood Pressure

Davey Smith et al have used instrumental variable regression to assess the effect of C-reactive protein (CRP) on blood pressure (BP) in a cross-sectional sample of women.1 By using the 1059G/C polymorphism of the CRP gene as an instrument, they attempted to avoid confounding by unmeasured variables and reverse causality bias and concluded that elevated CRP levels do not lead to high BP. However, this analysis has several limitations. First, the 1059G/C polymorphism is a poor instrument because its effect on CRP level is small. Reported differences in CRP levels between White subjects with the GG and the GC variants were 0.33 mg/L in 1 study,2 0.07 mg/L in another (GG versus GC+CC),3 and nonsignificant in 3 others.4–6 In fact, in the author’s own study the average between-genotype CRP difference was only 0.42 mg/L.1 In the only prospective study on the association of CRP and incidence of hypertension,7 the smallest average difference in CRP level associated to a statistically significant increase in risk was 1.10 mg/L, almost 3× larger than that reported by Davey Smith et al.1 Second, the findings from the …

Race and Gender Differences in C-Reactive Protein Levels

This study sought to determine whether there are race and gender differences in the distribution of C-reactive protein (CRP) levels. Few data are available comparing CRP distributions in different race and gender groups. Recent clinical practice recommendations for CRP testing for cardiovascular risk assessment suggest a uniform threshold to define high relative risk (>3 mg/l). We measured CRP in 2,749 white and black subjects ages 30 to 65 participating in the Dallas Heart Study, a multiethnic, population-based, probability sample, and compared levels of CRP between different race and gender groups. Black subjects had higher CRP levels than white subjects (median, 3.0 vs. 2.3 mg/l; p < 0.001) and women had higher CRP levels than men (median, 3.3 vs. 1.8 mg/l; p < 0.001). The sample-weight adjusted proportion of subjects with CRP levels >3 mg/l was 31%, 40%, 51%, and 58% in white men, black men, white women, and black women, respectively (p < 0.05 for each group vs. white men). After adjustment for traditional cardiovascular risk factors, estrogen and statin use, and body mass index, a CRP level >3 mg/l remained more common in white women (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.1 to 2.5) and black women (OR 1.7; 95% CI 1.2 to 2.6) but not in black men (OR, 1.3; 95% CI, 0.8 to 1.9) when compared with white men. Significant race and gender differences exist in the population distribution of CRP. Further research is needed to determine whether race and gender differences in CRP levels contribute to differences in cardiovascular outcomes, and whether thresholds for cardiovascular risk assessment should be adjusted for different race and gender groups.

C‐reactive protein is significantly associated with prostate‐specific antigen and metastatic disease in prostate cancer

To further analyse the relationship of c-reactive protein (CRP) levels to prostate cancer, by measuring CRP in men with prostate cancer and benign prostatic hypertrophy (BPH), as chronic inflammation has long been linked to cancers with an infectious cause and CRP is a nonspecific marker for inflammation, associated with prostate cancer incidence and progression. Data from 114 men, most of whom had had radioactive seeds implanted, were evaluated from November 1990 to April 2002. In addition, 27 men were included who had biopsy-confirmed BPH. CRP was assessed with an automated chemiluminometric high-sensitivity assay kit. There was no significant difference in CRP levels in men with localized prostate cancer or BPH but levels were significantly higher in men with bone metastases. There was also a significant correlation of CRP level with prostate-specific antigen (PSA) in those with cancer. Because PSA is correlated with disease stage, multiple linear regression was used with CRP as the dependent variable, and PSA and disease stage as independent variables. The regression was significant overall (P < 0.001) and the effect of disease stage on CRP (P < 0.001) was independent of the effect of PSA level (P = 0.001). The strong association of CRP with PSA, independent of tumour stage, suggests that inflammation might be fundamental in prostate cancer, and that chronic inflammation may be a legitimate target for prostate cancer chemoprevention and treatment.

Serum tryptase levels in acute coronary syndromes

Background Mast cell accumulation and activation have been demonstrated in the vulnerable shoulder regions of atherosclerotic plaques and at the actual sites of plaque erosion and rupture. When activated and degranulated, mast cells release tryptase, a neutral protease, capable of activating matrix metalloproteinases and predisposing to plaque rupture. We tested the hypothesis that in acute coronary syndromes the levels of serum tryptase would reflect mast cell activation. Methods and results The study population consisted of 183 patients admitted to the emergency room of 3 general hospitals because of acute chest pain of ischemic origin. Of these patients, 64 suffered from exertional angina presenting with acute chest pain, 60 had unstable angina, and 59 had acute myocardial infarction. Serum tryptase levels were analyzed from samples drawn, on average at 7 h, and also at 24 h after the onset of the chest pain. As controls served 41 patients admitted for surgical treatment of inguinal hernia or varicose veins. Serum tryptase levels remained stable within the observation period, and no differences were detected between the patient groups and controls. On the other hand, the differences in C-reactive protein levels reflected the extent of myocardial injury. Conclusions In ACS, serum tryptase levels are normal and remain stable. Our results do not exclude the possibility of local activation of coronary mast cells, but suggest that the excess quantity of tryptase acutely released from mast cells in ACS, if any, is not sufficient to be detected by measuring tryptase concentration in the systemic circulation.