High-sensivity C-reactive Protein Research Articles

Daily Soy–Catfish–Anchovy–Rice (SCAR) Porridge Increases 25(OH)D Serum Levels in Tuberculosis Patients with Vitamin D Receptor Gene Polymorphisms

BACKGROUND: The presence of vitamin D receptor (VDR) polymorphism and high levels of inflammatory markers are predisposing factors indicating disease progression and malnutrition. To meet nutritional needs in maintaining nutritional status in tuberculosis patients with VDR gene polymorphisms (TaqI or FokI), food that is easily absorbed and high in vitamin D, calcium, and protein is needed. This study was conducted to determine whether high vitamin D and calcium porridge called soy–catfish–anchovy–rice (SCAR) porridge would increase 25(OH)D serum levels and other parameters, including calcium, albumin, high-sensivity C-reactive protein (hs-CRP), and blood glucose serum levels.METHODS: The study was a parallel, open, clinical trial. There were 22 subjects in the intervention (I) group who received 50 g of SCAR porridge once per day along with dietary counseling, and 21 subjects in the control (C) group who only received dietary counseling. All subjects with TC and CC (TaqI) or TC and CC (FokI) genotype were included in this study. The intervention lasted for 14 days, and the parameters such as 25(OH)D, calcium, albumin, hs-CRP, and blood glucose serum levels were assessed before and after intervention between groups.RESULTS: All subjects in both groups completed the study. After 14 days of intervention, there was a significant increase in 25(OH)D (p=0.01) and decrease in hs-CRP (p=0.02) serum levels in the I group, and no change was observed in the C group. There was no significant difference in albumin and blood glucose serum levels.CONCLUSION: The results show that 50 g of SCAR porridge per day for 14 days is an effective supplementation that can increase 25(OH)D and decrease hs-CRP serum levels in tuberculosis patients with VDR gene polymorphism.KEYWORDS: vitamin D, hs-CRP, polymorphism, porridge

Effects of hydroxy citric acid on body weight and serum hepcidin level in women with non-alcoholic fatty liver disease a randomized clinical trial

ObjectiveThis study aimed to investigate effects of hydroxy citric acid (HCA) extracts from Garcinia Cambogia on weight and serum hepcidin level in women with non- alcoholic fatty liver diseases (NAFLD). DesignClinics of Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran MethodsThis randomized clinical trial was conducted on 40 obese women aged 18–50 years with NAFLD, which were randomly allocated into two groups: “HCA group” (who received low-calorie diet plus six HCA tablets per day) and “Control group" (who received a low-calorie diet only), for eight weeks. Anthropometric parameters, dietary intake, physical activity level, serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), high sensivity c-reactive protein (hs-CRP) as well as, plasma level of hepcidin were measured at baseline and at the end of the study. ResultsThere was a significant reduction in dietary intakes in both groups (p < 0.05). Weight and body mass index (BMI) decreased significantly in HCA group (p < 0.05), but the differences between two groups were not significant. Serum hepcidin level and hs-CRP increased slightly, but not significantly in both groups. Liver enzymes increased in the HCA group but decreased in the control group and there were significant differences between two groups (p = 0.004 for both of ALT and AST). ConclusionHCA can improve weight loss in NAFLD patients, while it may not have favorable effects on liver enzymes, hs-CRP and serum hepcidin level.IRCT number: 201503273320N11

The role of chemokine CCL5/RANTES and metalloproteinase-9 as inflammatory modulators in symptomatic internal carotid artery stenosis.

Up to 80% of all ischemic strokes (IS) attributed to internal carotid athero-occlusive artery stenosis (ICAS) are related to a thromboembolic mechanism. One athero-occlusive ischemic event increases the risk for ischemia in another vascular territory, resulting from inflammation within the atherosclerotic plaque induced by cytokines. Thus, ultrasonographic characteristics of vulnerable plaques in ICAS, including plaque echolucency and ulceration might correspond to cytokine activity. The present study aimed to investigate the associations between serum cytokines and atherosclerotic plaque characteristics and the 3-year risk of a major adverse coronary and carotid ischemic event (MACCE) in symptomatic patients treated for ICAS. Plaque characteristics on ultrasonography, serum levels of C-C motif chemokine ligand 5 (CCL5)/regulated on activation, normal T-cell expressed and secreted (RANTES), metalloproteinase-9 (MMP-9), interleukin-6 (IL-6), transforming growth factor beta (TGF-β), C-X-C motif chemokine ligand 16 (CXCL16), FAS ligand (FASL) and high sensivity C-reactive protein (hs-CRP) were analyzed in 103 symptomatic patients with ICAS prior to carotid revascularization. The incidence of MACCE: cardiovascular death (CVD), myocardial infarction (MI) and recurrent ischemic stroke (IS) were recorded prospectively for up to 5 years (median 37; IQR 21 - 40 months). Echolucent plaques, in comparison to echogenic plaques, displayed lower median levels of RANTES (P = 0.042) but higher median levels of IL-6 (P = 0.039). There was no relationship between plaque characteristics and median levels of MMP-9, TGF β, CXCL16, FASL, or hs-CRP (P = NS). During follow-up, MACCE occurred in 15 (14.6%) patients. Univariate Cox proportional hazard analysis indicated median RANTES levels < 45.5ng/mL (hazard ratio (HR) = 3.95; 95%CI = 1.10 - 14.2; P = 0.035), MMP-9 > 0.6 μg/mL (HR 4.5; 95%CI = 1.4 - 13.9; P = 0.009), renal impairment (HR 3.48; 95%CI = 1.29 - 9.34; P = 0.013) as potential MACCE risk factors. On multivariate Cox proportional hazard analysis, MMP-9 > 0.6 μg/mL and RANTES < 45.5 ng/ml were associated with a 4.72-fold (95%CI = 1.3 - 17.0; P = 0.017) and a 3.8-fold risk increase (95%CI = 1.07 - 13.89; P = 0.038) of MACCE. Kaplan-Meier analysis showed significant differences in MACCE-free survival rates depending on RANTES and MMP-9 median levels. We conclude that serum RANTES, IL-6, and MMP-9 were associated with plaque vulnerability and predicted adverse MACCE in patients treated for ICAS.

High and low dose atorvastatin effects on high sensivity C-reactive protein in patient with acute coronary syndrome

Introduction: The effect of statins in reducing the risk of acute cardiovascular events is not only due to their effect on serum cholesterol level but also from their anti-inflammatory effects, particularly those resulting from reducing of C - reactive protein (CRP), is important. Atorvastatin dose and duration of treatment display different effects. This study compared the effects of high and low doses atorvastatin in reducing serum level of high sensitivity C reactive protein (hs-CRP). Methods: One hundred patients with unstable angina or Non ST Elevation Myocardial Infarction (NSTEMI) randomized into two groups. Group 1 (n=50) received atorvastatin 80, 20 and 20 mg in three days but group 2 (n=50) received atorvastatin 80 mg/day for three days. High sensitivity C-Reactive protein was measured at admission time and after three dose atorvastatin therapy. Results: Hs-CRP significantly decreased from baseline to end of three doses treatment in both groups (P=0.0001). However, the reduced level was greater in the group2 than group1 (-39.5 vs -31.2, P=0.0185). Conclusion: We found that both treatment methods have significantly effect on hs-CRP in short term but high dose (80 mg/day) atorvastatin being associated with significantly greater reductions in hs-CRP concentration.

C-reactive protein and other cardiovascular biomarkers are prediction of long-term outcomes in patients undergoing percutaneous coronary intervention

Objective The association of high-sensivity C-reactive protein (hs-CRP) on patients undergoing percutaneous coronary intervention （PCI） and the long-term prognostic value were evaluated. Methods A prospective cohort study was prospectively conducted in 287 consecutive patients who were hospitalized in the Department of Cardiology of Shanghai Zhongshan Hospital undergoing primary PCI between Dec.2007 and Dec.2008. Levels of hs-CRP and other cardiovascular risk factors were determined before PCI. The patients were followed up for a mean of 54 months. Their cardiovascular end points were recorded. Results The mean value of serum hs-CRP in patients with cardiovascular disease （CVD） readmission and death was significantly higher than those without CVD readmission and death (2.21 mg/L versus 1.10 mg/L, Z=-3.152；6.60 mg/L versus 1.22 mg/L, Z=-3.192；P both 3.0 mg/L are 43.75%（35/80）and 8.75%（7/80）,respectively. The survival time was all less than 20 months. Conclusions The results demonstrated that hs-CRP is an independent risk factor in cardiovascular disease. High hs-CRP is strongly associated with 5-year occurance of readmission and death for cardiovascular events. Hs-CRP can be a strong indicator of risk stratification and prognostic evaluation on cardiovascular high-risk populations. （Chin J Lab Med,2014,37:213-218） Key words: Cardiovascular diseases; C-reactive protein; Biological markers; Prognosis

Biological efficacy of twice daily aspirin in type 2 diabetic patients with coronary artery disease

Diabetes is associated with a high rate of events after acute coronary syndrome and percutaneous coronary intervention despite aspirin treatment. Once daily aspirin might not provide 24-hour stable biological efficacy in patients with diabetes. We compared the biological efficacy of the same daily dose of aspirin given either once (OPD) or divided twice per day in a population of diabetic patients with previous coronary artery disease. Ninety-two consecutive diabetic patients with at least 1 criteria of time-dependent aspirin efficacy, elevated high-sensibility C-reactive protein (hs-CRP), fibrinogen, platelet count, or active smoking were prospectively included. Consecutive patients were randomly treated with 150-mg aspirin daily given either OPD (150 mg in the morning) or twice per day (75 mg in the morning and 75 mg in the evening) in a crossover study. The main outcome was platelet reactivity to arachidonic acid (0.5 mg/mL) measured by light transmission aggregometry at trough level before morning aspirin intake. Mean maximum aggregation intensity triggered by arachidonic acid was 19.7% ± 15.4% on OPD and 11.9% ± 10.4% on twice per day (P < .0001). Biological resistance (maximum aggregation intensity ≥20%) was observed in 42% of patients on OPD and 17% on twice per day (P < .001). Of the 39 patients with biological resistance on OPD, 24 (62%) overcame resistance on twice per day. Of the 16 resistant on twice per day, only 1 patient (6%) overcame resistance on OPD. Results were concordant with global evaluation of platelet reactivity by Platelet Function Analyzer-100. A better twice per day efficacy was independent of clopidogrel cotreatment. In a population of diabetic patients with coronary artery disease and a high risk of time-dependent aspirin resistance, aspirin divided twice per day can significantly decrease the rate of biological loss of efficacy at trough level.

Abstract 17540: The CC Variant of Locus 9p21 Increases Coronary Disease Risk with High Values of Hs-CRP

Recent genomic wide association studies have identified several loci associated with coronary artery disease (CAD) risk. Among them, SNP rs 1333049 in the locus 9p21 (variant CC) has demonstrated a solid association with CAD which has been replicated in several populations, namely ours. High sensibility C-reactive protein (hs-CRP) has also been associated with inflammatory activity and atherosclerosis. An eventual interaction among these two atherosclerotic markers is unknown. Aim: To explore the interaction between this homozygous genetic variant (CC) and hs-CRP plasmatic levels in the emergence of CAD. Methods: Case-control study with 1561 participants, 695 consecutive coronary patients (mean age 53.9±8.9 years, 78.8% male) and 838 controls without apparent CAD (mean age 52.0±11.4 years, 71% male) selected in order not to present significant differences in sex and age. The G/C variants were studied blindly using a combined technique of PCR and TaqMan. Hardy-Weinberg distribution was analyzed. The CAD risk was investigated by univariate analysis and the OR and 95% confidence intervals were calculated. hs-CRP values were distributed by quartiles and the highest one, considered as the risk, was evaluated. To determine the interaction between CC genotype and elevated hs-CRP values we used a 4x2 table approach, as well as synergy measurements in additive (SI) and multiplicative (SIM) models. Finally, the risk excess (RERI) and the attributable proportion (AP) due to the interaction were calculated. Results: The CC variant was significantly associated with CAD risk in the whole population (OR=1.32; p=0.011). The presence of this genetic variant with normal hs-CRP values presented a smaller risk (OR=1.28) when compared to the association with the elevated hs-CRP values in the highest quartile (OR=1.7; p=0.007; SI=1.63; SIM=1.15; RERI=0.27). Conclusion: The present study demonstrates that the CC variant of the 9p21 locus globally increases the risk of CAD. This risk can be further increased in the presence of elevated hs-CRP values, as shown by the addictive and multiplicative interaction. This concept allows us to foresee the possibility of genetic risk factors management through the control of associated conditions, whenever possible.

Association of the C677T MTHFR Polymorphism With Homocysteine, Ox-LDL Levels, and Thiolactonase Activities in the Severity of Coronary Syndrome

Coronary artery diseases (CAD) are influenced by multiple genes of modest effect as the methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism, related to MTHFR activity and total plasma homocysteine (tHcy) concentration. This study was designed to evaluate tHcy, oxidized low-density lipoprotein (LDL) (ox-LDL), high-sensibility C-reactive protein (Hs CRP) levels, and homocysteine thiolactonase (HTase) activities as new risk factors for CAD and to investigate an association between MTHFR polymorphism tHcy concentrations and coronary syndrome severity. Our results showed significantly higher levels of tHcy and ox-LDL in patients associated with lower HTase activities. These levels increased proportionally to disease severity. Total plasma Hcy levels were negatively correlated to HTase activities in patients where the TT genotype was significantly more frequent. In a multivariate analysis, tHcy level was the only independent factor affecting the coronary syndrome severity. High tHcy levels are associated with coronary syndrome severity and may be explained either by the elevated prevalence of TT genotype or by the diminished HTase activities.

Intérêt de la C-reactive protein (CRP) dans l’évaluation pronostique de l’infarctus du myocarde revascularisé

During myocardial infarction (MI), numerous biomarkers increase, such as troponin (necrosis), BNP, and high sensibility C-reactive protein (hsCRP) (inflammation). The objectives of the study were to study kinetics of hsCRP after a revascularized MI, and correlations between hsCRP and clinical outcomes or biological markers, and prognostic value of CRP.Fifty-two patients were admitted for STEMI (ST segment Elevation MI). Primary coronarography interventions (PCI) were performed for urgent reperfusion. Patients were included only in case of success (TIMI 3). Clinical examination was completed by a biological follow-up of BNP, troponin-I (before and after PCI, days 1, 2, 3, 6) and hsCRP (days 0, 1, 2, 3, 6). Clinical outcomes follow-up was performed during hospitalization, on the first month, and the sixth month.hsCRP increases during the first days (peak on day 3: 46.1mg/L), and decreases between the third and the seventh day. Clinical outcomes were correlated with CRP: door-to-balloon time, age, creatinin level on admission. During follow-up, there were clinical events in 13/49 (26%) of the patients. Among them, hsCRP on day 2 was higher (p < 0.0001), compared to other patients. Compared to other biological markers, hsCRP was correlated with BNP on days 2 and 3 (p = 0.008).hsCRP increases after revascularized STEMI, in accordance to the infarct size, in the first days. hsCRP is correlated with cardiovascular pronostic biomarkers. hsCRP could play an active role, and could be used as a pronostic biomarker after revascularized STEMI, which are usually considered as a low-risk population.

Inflammatory marker—high-sensivity C-reactive protein in ischemic heart disease patients after coronary artery bypass grafting

Inflammatory marker—high-sensivity C-reactive protein in ischemic heart disease patients after coronary artery bypass grafting

OC43: Intrauterine growth restriction and cardiovascular disease before and after birth

Objectives: To assess abdominal aortic wall thickness in utero and after birth in fetuses affected by intrauterine growth restriction (IUGR) and according to gestational age (AGA), and to evaluate at birth troponin I and T and high-sensibility C-reactive protein levels to determine if IUGR fetuses have a higher risk of cardiovascular disease after birth. Methods: A prospective study has been performed on 32 IUGR fetuses and 32 AGA fetuses. In all fetuses measurements of abdominal aorta thickness were performed in utero and after delivery. At delivery a sample was taken from the umbilical vein for analysis of troponin I and T and high-sensibility C-reactive protein. Results: In IUGR fetuses abdominal aortic thickness (2.3 ± 0.5 mm) was significantly higher than that in AGA fetuses (1.5 ± 0.45 mm) (P 6 mg/L), whereas values were normal in AGA fetuses (P < 0.0001). Conclusions: Signs of cardiovascular diseases in IUGR fetuses may be investigated by ultrasonography and biochemical markers before and after birth.

Estado inflamatorio de los pacientes con fibrilación auricular antes y después de la cardioversión eléctrica

To assess the inflammatory state in patients with persistent atrial fibrillation and to determine the predictive value in the success of cardioversion and recurrence at 30 days. Prospective observational case-control study. We included consecutively 49 patients with atrial fibrillation previously to scheduled electrical cardioversion in Coronary Care Unit. Clinical and echocardiographic variables were registered and High-sensivity C-reactive protein, interleukin-1beta, interleukin-6 and Tumour Necrosis Factor-alpha were measured. At 30-days follow-up, rhythm and biomarkers were reassessed. As control groups, we recruited 27 healthy volunteers and 16 patients matched for age, gender and cardiovascular risk factors. Median age was 66 +/- 10 years and 38% were women. All the markers were higher in patients than in both control groups (p < 0.05). FNT-alpha and Interleukin-6 levels were higher in non-cardiovertors but only an enlarged atria was related to unsuccessful cardioversion (p = 0.036). High-sensivity C-reactive protein values in the higher cuartile tended to be related to recurrence of persistent atrial fibrillation (p = 0.06). There is an increased inflammatory state in patients with atrial fibrillation. FNT-alpha and Interleukin-6 levels were increased in non-cardiovertors, but no biomarker was associated with success of cardioversion or rhythm state at 30-days. However, higher levels of hs-CRP showed a trend to be related to recurrence of atrial fibrillation.

Risk stratification of emergency department patients with chest pain using d-dimer and high-sensivity C-reactive protein

Study objectives: Several recent reports in the literature have shown positive association between HS-CRP and d-dimer levels with diagnosis of acute coronary syndrome. Our study aims to find out whether these 2 markers would be useful in the risk stratification of patients presenting to the emergency department (ED) with undifferentiated chest pain. Methods: One hundred twenty-three patients, aged 25 years or older, were recruited when they presented to the ED with nontraumatic chest pain. They were evaluated and treated at the discretion of the treating physician but had additional d-dimer and HS-CRP done. Treating physicians were blinded to the results of these tests. Patients who had no history of ischemic heart disease and were diagnosed to have noncardiac chest pain underwent cardiac stress testing or other appropriate investigations to exclude cardiac ischemia and confirm their diagnoses. Final diagnoses were determined by cardiologists. These patients were followed up for mortality, ischemic events, and related hospital admissions at 1 week and 6 months after ED visit. Results: There was a nonsignificant difference in the mean HS-CRP levels of patients with acute coronary syndrome and noncardiac chest pain. However, HS-CRP level for patients with related admission within 1 week of presentation was 41.5 mg/dL compared with 3.4 mg/dL for patients who did not have related admission ( P =.01). There was no significant difference for mortality rate or related admission at 6 months. d-dimer levels of patients with angina were significantly higher than those of patients with noncardiac chest pain. They were 143.9 μg/L and 99.7 μg/L, respectively ( P =.016). Thirteen patients had acute myocardial infarction within 1 week of the presenting episode, and they had a mean d-dimer level of 154.9 μg/L compared with mean d-dimer level of 95.8 μg/L for patients who did not have acute myocardial infarction within 1 week of the presenting episode ( P =.013). Twenty-three patients had a related admission within 6 months. Their mean d-dimer level of 150.7 μg/L was significantly higher than the 91.7 μg/L for patients who did not have a related admission within 6 months ( P =.001). Conclusion: Our findings suggest that high HS-CRP level predicted a related admission within 1 week of the presenting episode, which is potentially useful in risk stratification. A patient with risk factors and atypical-sounding pain but high HS-CRP level will probably need more urgent further cardiac evaluation after acute myocardial infarction had been ruled out than a patient who had normal HS-CRP levels. A higher d-dimer level was associated with an increased risk of coronary artery disease. Patients with higher levels of d-dimer were also more likely to have acute myocardial infarction within 1 week of presentation with chest pain and have a related admission within 6 months. These patients should be evaluated as soon as possible by a cardiologist for definitive treatment. Our study numbers are too small for us to recommend a cutoff value for HS-CRP and d-dimer levels at which the clinician should be alarmed. Further studies with larger patient recruitment would help elucidate this issue.