hs-CRP In Group Research Articles

Relationship between Fat Mass and Serum High-Sensitivity C-Reactive Protein Levels in Prevalent Hemodialysis Patients

Background/Aims: Little is known about the relationship between fat mass distribution and chronic inflammation in dialysis patients, in whom chronic inflammation is related to morbidity and mortality. Methods: The fat and lean masses (truncal and nontruncal) of 452 hemodialysis patients (age: 64 ± 11 years; hemodialysis duration: 89 ± 77 months; 37% diabetics) were measured by dual X-ray absorptiometry and their association with high-sensitivity C-reactive protein (hsCRP) was examined. Results: The fat mass of the high hsCRP group (n = 106) was significantly higher than that of the normal hsCRP group (n = 346; p < 0.05); there were no significant differences in lean mass between the two groups. Truncal fat mass of the former group was significantly greater than that of the latter (p < 0.05), but there was no significant difference in nontruncal fat mass between the two groups. In multiple regression analysis, truncal fat mass (β = 0.227, p < 0.01) was significantly and independently associated with serum hsCRP levels after adjustment for age, gender and serum albumin (R² = 0.137, p < 0.01), whereas nontruncal fat mass was not. Conclusion: Fat mass, particularly truncal fat mass, but not lean body mass, was significantly associated with serum hsCRP levels. The results suggest that truncal fat mass exhibits a distinct effect on chronic inflammation in hemodialysis patients.

Metabolic factors and high-sensitivity C-reactive protein: the HUNT study

The association of high-sensitivity C-reactive protein (hsCRP) with metabolic syndrome in younger age groups has not been studied extensively and few population-based studies have included both sexes. Therefore we estimated the association of high-sensitivity C-reactive protein (hsCRP) with the metabolic factors at different ages in men and women in a large population-based study. In this cross-sectional study, clinical information and non-fasting blood samples including measurement of hsCRP from 4587 men and 5408 women 20 years and older in the HUNT study in Norway were used to study the association of components of the metabolic syndrome with levels of hsCRP, by sex and age group. All measured metabolic factors were associated with hsCRP. Among these factors, body mass index appeared to be the most strongly associated, and the strong positive association persisted also after adjustment for the other metabolic factors, with similar associations in women and men. The associations were generally somewhat stronger in younger than in older age groups. Metabolic factors, especially body mass index, have a relatively strong association with high-sensitivity C-reactive protein at all ages both in men and women.

Influence of pericoronary adipose tissue on local coronary atherosclerosis as assessed by a novel MDCT volumetric method

ObjectivePericoronary adipose tissue (PCAT) may create a pro-inflammatory state, contributing to the development of coronary artery disease (CAD). We sought to evaluate the feasibility of a novel volumetric PCAT quantification method using a novel threshold based computed tomography approach. In addition we determined the relation between PCAT volumes and CAD. MethodsIn 51 patients (49.5±5.1 years, 64.8% male) who underwent 64-slice MDCT, we measured threshold-based PCAT volumes using distance and anatomic-based methods. Using the most reproducible method, we performed the proximal 40-mm distance measurement in three groups as stratified by coronary plaque and high-sensitivity C-reactive protein (hs-CRP) levels: Group 1 (presence of coronary plaque, hs-CRP >2.0mg/L); an intermediate group (Group 2, no plaque, hs-CRP >2.0mg/L); and Group 3 (no plaque, hs-CRP<1.0mg/L). We compared PCAT volumes to the presence of coronary plaque on a patient (n=51) and vessel (n=153) basis. On a subsegment basis (n=1224), we compared PCAT volume to the presence of plaque as well as plaque morphology. ResultsDistance-based PCAT volume measurements yielded excellent reproducibility with intra-observer intraclass correlation (ICC) of 0.997 and inter-observer ICC of 0.951. On a both a per-patient and per-vessel analysis, adjusted PCAT volume was greater in patients with plaque (Group 1) than without plaque (Groups 2 and 3, p<0.001). No difference in PCAT volume was seen between high and low hs-CRP groups without plaque (p=0.51). Adjusted PCAT volumes were higher in subsegments with plaque as compared without (p<0.001). Additionally, adjusted PCAT volume was greatest in subsegments with mixed plaque followed by non-calcified plaque, calcified plaque, and the lowest volume in segments with no plaque (p<0.001). ConclusionIn this proof-of-concept study, threshold based PCAT volume assessment is feasible and highly reproducible. PCAT volume is increased in patients and vessels with coronary plaques. Surrounding vessel subsegments with coronary plaque, particularly mixed plaques, have greatest PCAT volume and highlight the effect of local PCAT in the development of coronary atherosclerosis.

ASSOCIATION OF HSCRP AND SIX MONTHS ANGIOGRAPHIC AND TWO YEARS CLINICAL OUTCOMES OF THE PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION WITH DRUG-ELUTING STENTS

Results: High hs CRP group had more elderly and smoker, more STEMI and NSTEMI, and lower left ventricular ejection fraction (LVEF). Six-month angiographic outcomes were similar between two groups and pts of high hs CRP group showed higher cumulative cardiac death (CD) and total major cardiac adverse event (MACE) up to 2 years compared with control group. High hsCRP was an independent risk factor of CD (Adjusted OR: 11.290, 95% CI:3.847-33.133, p-value=0.001) and total MACE up to 2 years (Adjusted OR: 2.712, 95% CI:1.854-3.967, p-value=0.001) (Table).

Impact of the Sasang Constitutional Type on the High-Sensitivity C-Reactive Protein, a Predictor of Cardiovascular Disease

Abstract Impact of the Sasang Constitutional Type on the High-Sensitivit yC-Reactive Protein, a Predictor of Cardiovascular Disease Mi-Jeong Kang * , Ji-Won Lee, Eui-Ju Lee, Byung-Hee Koh, Jun-Hee LeeDept. of Sasang Constitutional Medicine. College of Oriental Medicine, Kyung Hee University. Seoul. Korea * Kyung Hee University. Seoul. Korea 1. Objectives The purpose of this study was to investigate the high-sensitivity C-reactive protein (hsCRP) related characteristics found in each Sasang Constitutional type. 2. Methods This cross-sectional epidemiological study was conducted using data from 2,842 men and women. After typing each participant into one of the four Sasang constitutional types, they were analyzed on various cardiovascular disease-related variables. 3. Results 1) The predictors of cardiovascular disease (metabolic syndrome, high risk FRS group, high risk hsCRP group) was found to show the highest prevalence in the Taeeum type.2) In the group with metabolic syndrome, the mean hsCRP concentration in the Taeeum and Soyang types were higher than in the Soeum type. In the group without metabolic syndrome, the mean hsCRP concentration in the Taeeum type were higher than in the Soyang and Soeum types. 3) In the FRS low risk group, the mean hsCRP concentration were higher in order of Taeeum type > Soyang type > Soeum type. In the FRS high risk group, the mean hsCRP concentrations were not significantly different among the Sasang constitutional types.

E0493 To explore the relationship between high-sensitivity C-reactive protein and the prognosis of patients with acute myocardial infarction after percutaneous coronary intervention

ObjectiveTo explore the relationship between high-sensitivity C-reactive protein and the prognosis of patients with acute myocardial infarction after percutaneous coronary intervention.MethodsThe study comprised 100 consecutive patients with first attack of...

Association of maternal serum high sensitive C‐reactive protein level with body mass index and severity of pre‐eclampsia at third trimester

To assess a maternal serum level of high sensitive C-reactive protein (hs-CRP) as a useful clinical parameter in prediction of pre-eclampsia severity and, to evaluate the correlation between hs-CRP and body mass index (BMI). Using cross-sectional study design, CRP was measured by a high sensitive immunoturbidimetric method between 24 and 40 weeks of gestation in normotensive controls (n = 115), in mild (n = 63) and severe (n = 34) pre-eclamptic patients. The receiver operating characteristic analysis was used to estimate the optimal threshold score of hs-CRP. For disease severity evaluation, a hs-CRP concentration of 9.66 mg/L was determined as cut-off point with 88% sensitivity, 81% specificity, 71% positive predictive value and 92% negative predictive value. When all three groups of patients were adjusted for gestational age [24(°/7) -27,(6/7) 28(°/7) -33,(6/7) 34(°/7) -40(6/7) ] and BMI, hs-CRP levels of severe pre-eclamptic patients were significantly higher than mild ones and controls in the study group with BMI < 25 kg/m(2) (P < 0.001). In the study group with BMI ≥ 25 kg/m(2), only severe pre-eclamptic patients between 28(°/7) and 33(6/7) weeks of gestation had significantly higher hs-CRP levels when compared with control and mild pre-eclamptic group (P < 0.001). When the patients were subgrouped as high (≥ 9.66 mg/L) and low hs-CRP group (< 9.66 mg/L), adverse outcomes for hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and intrauterine growth-restricted baby were statistically significant higher in high hs-CRP group (P = 0.004 and P < 0.001, respectively). Elevated level of hs-CRP is a useful parameter in the severity of clinical risk of pre-eclampsia in patients with BMI < 25 kg/m(2) at third trimester.

Slightly Elevated High-Sensitivity C-Reactive Protein (hsCRP) Concentrations Are Associated With Carotid Atherosclerosis in Women With Varying Degrees of Glucose Tolerance

We examined whether high-sensitivity C-reactive protein (hsCRP) ≥2.0 mg/L was associated with increased intima-media thickness (IMT), plaque burden, and plaque echolucency in carotid arteries. Women (n = 635) from a population sample of 64-year-old females with varying degrees of glucose tolerance underwent risk factor assessment, measurement of hsCRP, and ultrasound examinations of the carotid arteries. Participants with hsCRP levels ≥2.0 mg/L had elevated carotid bulb IMT independently of other cardiovascular risk factors compared with those with hsCRP <2.0 mg/L. The participants with plaques in the highhsCRP group had larger total plaque area compared to those with plaque in the lower hsCRP group. Plaque echolucency did not differ between groups. High-sensitivity CRP levels ≥2.0 mg/L were accompanied by elevated IMT in the carotid bulbs independently of other cardiovascular risk factors. Total plaque area was larger among women with plaques in the high hsCRP group versus the lower hsCRP group.

Prognostic Implications of the High-Sensitive C-Reactive Protein in the Catheter Ablation of Atrial Fibrillation

Previous studies have reported that increased high-sensitive C-reactive protein (hs-CRP) levels are associated with an inflammatory state. This study investigated the association among hs-CRP, substrate properties, and long-term clinical outcomes after catheter ablation of atrial fibrillation (AF). A total of 137 patients with AF (54 +/- 13 years) who underwent mapping and catheter ablation were included. The hs-CRP was measured before the first ablation procedure. The substrate properties (initiating triggers, biatrial mean voltage, and high-frequency sites) of the 2 atria and long-term outcome were investigated in patients in the low hs-CRP group (<75%, 2.92 mg/L) and high hs-CRP group (>75%, 2.92 mg/L). Patients with a higher hs-CRP were associated with an increased number of identified nonpulmonary vein ectopies (34.4% vs 17%, p = 0.034), lower mean left atrial (LA) voltage (1.72 +/- 0.73 vs 1.92 +/- 0.72 Hz, p = 0.045), and higher-frequency sites in the left atrium (71% vs 37%, p = 0.027). After a median follow-up period of 15 months, the single-procedure success rate (72% vs 53%, p = 0.008) and final success rate after multiple procedures (94% vs 81%, p = 0.02) were higher in the low hs-CRP group. In a multivariable regression model adjusted for other potential covariates, hs-CRP level (p = 0.021) and LA diameter (p = 0.032) were independent predictors of recurrence. In conclusion, baseline CRP levels before the first AF ablation procedure had an independent prognostic value in predicting long-term recurrence. Patients with a high hs-CRP level were associated with an abnormal LA substrate and high incidence of nonpulmonary vein AF sources.

Chronic low-grade inflammation, lipid risk factors and mortality in functionally dependent elderly

It has been proved that a highly sensitive C-reactive protein (hsCRP) can be used as an established marker of chronic inflammation for cardiovascular risk assessment. Since mean values of both low-density cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) decrease during aging, the knowledge that increased hsCRP concentration predicts mortality (Mt) would influence therapy and treatment outcome. The aim of this study was to examine importance of chronic low grade inflammation and its association with lipid risk factors for all-cause Mt in functionally dependent elderly. The participants of this longitudinal prospective study were 257 functionally dependent elderly aged 65-99 years. Baseline measurements: anthropometric measurements, blood pressure, fasting plasma total cholesterol (TC), triglyceride (TG), HDL-C, LDL-C, non-HDL-C, hemoglobin Alc (HbA1c) were recorded and different lipid ratios were calculated. Inflammation was assessed by the levels of white blood cells, fibrinogen and hsCRP. The participants with hsCRP grater than 10 mg/L were excluded from the study. The residual participants (77.4% women) were divided into three groups according to their hsCRP levels: a low (< 1 mg/L, n=70), average (1 to 3 mg/L, n=69), and high (3-10 mg/L, n=69) hsCRP group. Associations of all-cause Mt with different risk factors were examined using logistic regression analysis. The hsCRP level showed a significant positive correlation with waist (r = 0.199, p = 0.004) and hip (r = 0.187, p = 0.007) circumferences, body mass index (r = 0.143, p = 0.040) and serum triglyceride level (r = 0.139, p = 0.045) and significant negative correlation with HDL-C (r = -0.164, p = 0.018). Ratios TC/HDL-C and TG/HDL-C were significantly smaller in the low hsCRP group compared to the average hsCRP group (p = 0.019,p = 0.045, respectively) and without significant differences compared with the high hsCRP group. Two years after the baseline examination 22.1% participants died from all-cause Mt. After adjustment for other risk factors, a TC was significantly associated with all-cause Mt only in high hsCRP group: Odds ratio (OR) = 3.71 (95% confidence interval-CI: 1.09-12.63). In this study a high hsCRP was an important factor to identify functionally dependent elderly at high risk who may have more benefit from agressive lipid lowering treatment.

High-sensitivity C-reactive protein and plaque composition in patients with stable angina pectoris: a virtual histology intravascular ultrasound study

Elevated high-sensitivity C-reactive protein (hs-CRP) is related to clinical outcome in coronary artery disease. We used virtual histology intravascular ultrasound to evaluate the relationship between serum hs-CRP level and coronary plaque composition in patients with stable angina pectoris. Overall 113 consecutive patients with stable angina pectoris who had a de-novo culprit lesion were examined in this study. Patients were divided into an elevated hs-CRP group (>3 mg/l; n=40) or a normal hs-CRP group (n=73). Grayscale and virtual histology intravascular ultrasound analysis was performed across the entire culprit lesion. Mean plaque area was similar in both groups. Lesion length (18+/-5 vs. 16+/-6 mm, P<0.046) was significantly greater in the elevated hs-CRP group than that in the normal hs-CRP group. Although the percentage of dense calcium, fibrofatty tissue, and fibrous tissue was not different between the two groups, the percentage of necrotic core was significantly greater in the elevated hs-CRP group compared with the normal hs-CRP group (20+/-9 vs. 16+/-8%, P=0.014). The percentage of necrotic core was positively correlated with the serum hs-CRP level (r=0.20, P=0.037). A multivariate logistic regression model showed that the percentage of necrotic core was associated with elevated hs-CRP (P=0.019; odds ratio=1.1; 95% confidence interval=1.01-1.12). Elevated hs-CRP was related to the amount of necrotic core in the culprit lesion of stable angina pectoris. Our results suggest that elevated hs-CRP might reflect the inflammatory activity of the coronary atherosclerotic plaque even in the setting of stable angina pectoris.

Effects of Statin Therapy According to Plasma High-Sensitivity C-Reactive Protein Concentration in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA)

We examined whether the antiinflammatory action of statins may be of benefit in heart failure, a state characterized by inflammation in which low cholesterol is associated with worse outcomes. We compared 10 mg rosuvastatin daily with placebo in patients with ischemic systolic heart failure according to baseline high sensitivity-C reactive protein (hs-CRP) <2.0 mg/L (placebo, n=779; rosuvastatin, n=777) or > or = 2.0 mg/L (placebo, n=1694; rosuvastatin, n=1711). The primary outcome was cardiovascular death, myocardial infarction, or stroke. Baseline low-density lipoprotein was the same, and rosuvastatin reduced low-density lipoprotein by 47% in both hs-CRP groups. Median hs-CRP was 1.10 mg/L in the lower and 5.60 mg/L in the higher hs-CRP group, with higher hs-CRP associated with worse outcomes. The change in hs-CRP with rosuvastatin from baseline to 3 months was -6% in the low hs-CRP group (27% with placebo) and -33.3% in the high hs-CRP group (-11.1% with placebo). In the high hs-CRP group, 548 placebo-treated (14.0 per 100 patient-years of follow-up) and 498 rosuvastatin-treated (12.2 per 100 patient-years of follow-up) patients had a primary end point (hazard ratio of placebo to rosuvastatin, 0.87; 95% confidence interval, 0.77 to 0.98; P=0.024). In the low hs-CRP group, 175 placebo-treated (8.9 per 100 patient-years of follow-up) and 188 rosuvastatin-treated (9.8 per 100 patient-years of follow-up) patients experienced this outcome (hazard ratio, 1.09; 95% confidence interval, 0.89 to 1.34; P>0.2; P for interaction=0.062). The numbers of deaths were as follows: 581 placebo-treated (14.1 per 100 patient-years of follow-up) and 532 rosuvastatin-treated (12.6 per 100 patient-years) patients in the high hs-CRP group (hazard ratio, 0.89; 95% confidence interval, 0.79 to 1.00; P=0.050) and 170 placebo-treated (8.3 per 100 patient-years) and 192 rosuvastatin-treated (9.7 per 100 patient-years) patients in the low hs-CRP group (hazard ratio, 1.17; 95% confidence interval, 0.95 to 1.43; P=0.14; P for interaction=0.026). In this retrospective hypothesis-generating study, we found a significant interaction between hs-CRP and the effect of rosuvastatin for most end points whereby rosuvastatin treatment was associated with better outcomes in patients with hs-CRP > or = 2.0 mg/L. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00206310.

Clinical Significance of Inflammatory Markers in Polycystic Ovary Syndrome: Their Relationship to Insulin Resistance and Body Mass Index

Background: Women with polycystic ovary syndrome (PCOS) have an increased prevalence of insulin resistance (IR) and related disorders. Elevated serum levels of high sensitivity CRP (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factorα(TNF-α) reflect low-grade chronic inflammation and have been associated with several insulin-resistant states; they are useful cardiovascular risk markers. The objective of this study was to investigate whether soluble inflammatory markers are altered in PCOS focusing on its relationship with obesity and indexes of insulin resistance.Patients and methods: One hundred and eight women with PCOS and 75 healthy women were recruited. Patients were divided according to body mass index (BMI) into two groups; group I (BMI &lt; 27 kg/m2) and group II (BMI ≥ 27 Kg/m2). Serum levels of hs-CRP, IL-6, and TNF-α, lipid and hormone profiles were measured.Results: PCOS patients had increased levels of testosterone, luteinizing hormone (LH), androstendione, insulin level and HOMA index compared to healthy BMI matched controls. High-density lipoprotein (HDL) concentrations were significantly reduced in both patient groups compared to their controls, while triglyceride levels were significantly increased in obese group compared to controls. There were no significant difference in serum inflammatory markers hs-CRP, IL-6 and TNF-αbetween group I and their matched controls. On the other hand, there were significant increase in these markers between group II and their matched controls. There were highly significant positive correlation between hs-CRP and IL-6 (r= 0.702,P&lt; 0.001) and between hs-CRP and TNF-α(r= 0.621,P&lt;0.001), also between IL-6 and TNF-α(r= 0.543,P&lt; 0.001). These inflammatory markers correlated significantly with BMI and HOMA index. Multiple regression analysis revealed that BMI and HOMA were predictors of IL-6 levels (b= 11.173,P&lt; 0.001,b= 13.564,P&lt; 0.001 respectively) and BMI was the only predictor of hs-CRP levels (b= 12.578,P&lt; 0.001) and TNF-αlevels (b= 0.134,P&lt; 0.001).Conclusion: PCOS and obesity induce an increase in serum inflammatory cardiovascular risk markers. The precise mechanisms underlying these associations require additional studies to clarify the state of the cardiovascular system in women with PCOS compared with controls in large numbers of patients to determine the relative contribution of different factors including insulin resistance, androgen status and BMI.

Abstract 2370: LDL Independent Reduction In Cardiovascular Morbidity And Mortality With Rosuvastatin In Heart Failure Patients With A Raised C-reactive Protein: A Retrospective Analysis Of The Controlled Rosuvastatin Multinational Trial In Heart Failure (CORONA)

Objective: The anti-inflammatory action of statins may contribute to the clinical benefits of these drugs. Heart failure (HF) is an inflammatory state in which the usual epidemiologic relationship between cholesterol and cardiovascular outcomes is reversed, representing an excellent disease model in which to test the statin anti-inflammatory hypothesis. Methods: We carried out a retrospective subgroup analysis of CORONA, which randomized 5011 patients with low ejection fraction HF of ischemic etiology to placebo or rosuvastatin 10 mg daily. We examined the effect of rosuvastatin according to baseline plasma high-sensitivity C-reactive protein concentration (hs-CRP) with patients divided into two groups: &lt; 2 mg/L (779 placebo/777 rosuvastatin) versus &gt;/= 2 mg/L (1694 placebo/1711 rosuvastatin). Results (table ): Baseline LDL was the same in the two hsCRP groups (approx. 138 mg/dL) and was reduced equally by 45% in each group with rosuvastatin. In patients with a hsCRP &gt;/= 2 mg/L, rosuvastatin treatment was associated with nominally statistically significant reductions in the primary outcome (cardiovascular death, myocardial infarction or stroke), all cause mortality and the pre-specified coronary endpoint (sudden death, fatal or nonfatal myocardial infarction, PCI or CABG, ventricular defibrillation by an ICD, resuscitation after cardiac arrest or hospitalization for unstable angina). Importantly, rosuvastatin also reduced the secondary outcome of HF hospitalizations: hsCRP &lt; 2.0 mg/L 267 placebo/264 rosuvastatin (p n.s.); hsCRP &gt;/= 2.0 mg/L 1015 placebo/827 rosuvastatin (p = 0.0044) Conclusions: Our findings in patients with HF support and extend previous retrospective analyses in patients with acute and stable coronary heart disease and add more evidence that the anti-inflammatory action of statins may be clinically important, not just in reducing atherosclerotic events but also HF hospitalizations.

Nitric oxide overproduction derived from inducible nitric oxide synthase increases cardiomyocyte apoptosis in human atrial fibrillation

Background Inflammation and oxidant stress have been suggested to be involved in the structural remodeling in atrial fibrillation (AF), and inducible nitric oxide synthase (iNOS) is associated with inflammation and oxidant stress. To study whether iNOS could contribute to atrial remodeling in AF, we investigated the relationship between inflammation, oxidant stress, nitric oxide (NO) and its synthase, and cardiomyocytic apoptosis in the right atrium in human AF. Methods Fifteen patients with permanent AF (PmAF) and 17 patients with sinus rhythm (SR), who underwent mitral valve replacement surgery were investigated. Western blotting and immunohistochemical staining were used to detect the expression of endothelial nitric oxide synthase (eNOS), iNOS and 3-nitrotyrosine (3NT; a biological marker of peroxynitrite) in the right atrium. The occurrence of cardiomyocytic apoptosis was determined by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL). Caspase 3 staining for the activated, cleaved protease was also performed. In addition, concentrations of NO 2 −/NO 3 − (NO X ) both in plasma and in the right atrium were measured by a NO X Detection Kit. Finally, plasma levels of high-sensitivity C-reactive protein (hs-CRP) were routinely measured. Results and conclusions Levels of hs-CRP were far more enhanced in patients with PmAF compared to the controls. Plasma levels of NO X were significantly lower in PmAF patients than SR patients, but the production of NO X in the local right atrium increased obviously. Furthermore, iNOS and 3NT expressions increased dramatically in the right atrium in PmAF patients, whereas the expression of eNOS did not change apparently. In addition, when patients were further divided into a higher hs-CRP group (≥ 5 mg/L) and a lower hs-CRP group (< 5 mg/L) according to the hs-CRP level, significant upregulation of iNOS was found in the higher hs-CRP group. Apoptosis index and caspase 3 staining were also prominently enhanced in PmAF patients compared with SR patients. More importantly, we demonstrated in this study that a higher expression of 3NT was associated with an increased expression of iNOS/eNOS ( r = 0.74, P < 0.05) and an enhanced apoptosis index ( r = 0.69, P < 0.05). In conclusion, the results presented novel evidence that imbalanced expression of iNOS/eNOS could contribute to protein nitration and cardiomyocyte apoptosis in human AF, in which condition inflammation may be an important participant.

Early remodeling of lower extremity vein grafts: Inflammation influences biomechanical adaptation

The remodeling of vein bypass grafts after arterialization is incompletely understood. We have previously shown that significant outward lumen remodeling occurs during the first month of implantation, but the magnitude of this response is highly variable. We sought to examine the hypothesis that systemic inflammation influences this early remodeling response. A prospective observational study was done of 75 patients undergoing lower extremity bypass using autogenous vein. Graft remodeling was assessed using a combination of ultrasound imaging and two-dimensional high-resolution magnetic resonance imaging. The vein graft lumen diameter change from 0 to 1 month (22.7% median increase) was positively correlated with initial shear stress (P = .016), but this shear-dependent response was disrupted in subjects with an elevated baseline high-sensitivity C-reactive protein (hsCRP) level of >5 mg/L. Despite similar vein diameter and shear stress at implantation, grafts in the elevated hsCRP group demonstrated less positive remodeling from 0 to 1 month (13.5% vs 40.9%, P = .0072). By regression analysis, the natural logarithm of hsCRP was inversely correlated with 0- to 1-month lumen diameter change (P = .018). Statin therapy (beta = 23.1, P = .037), hsCRP (beta = -29.7, P = .006), and initial shear stress (beta = .85, P = .003) were independently correlated with early vein graft remodeling. In contrast, wall thickness at 1 month was not different between hsCRP risk groups. Grafts in the high hsCRP group tended to be stiffer at 1 month, as reflected by a higher calculated elastic modulus (E = 50.4 vs 25.1 Mdynes/cm2, P = .07). Early positive remodeling of vein grafts is a shear-dependent response that is modulated by systemic inflammation. These data suggest that baseline inflammation influences vein graft healing, and therefore, inflammation may be a relevant therapeutic target to improve early vein graft adaptation.

Diagnostic performance of plasma high sensitive C‐reactive protein in detecting three‐vessel coronary artery disease: modification by apolipoprotein E genotype

Objectives. Plasma high sensitive C‐reactive protein (hsCRP) concentration is an important clinical test of systemic inflammation and, like apoE ε4 allele, an important risk factor of coronary artery disease (CAD). We investigated whether the diagnostic performance of plasma hsCRP in detecting severe 3‐vessel CAD may be modified by apoE ε4 carrier status. Methods. The study population (Angiography and Genes Study) comprised 485 Finnish subjects (336 men and 149 women, mean age 64.0±1.0) undergoing coronary angiography. ApoE genotypes were determined by the PCR‐based method and by hsCRP using an automatic analyser. Results. The diagnostic performance of hsCRP concentration in distinguishing 3‐vessel CAD from its less widespread forms (non‐3‐vessel CAD) was assessed by receiver operating characteristic curve (ROC) analysis separately in apoE ε4 non‐carriers and ε4 carriers. ROC analysis showed that hsCRP predicted 3‐vessel CAD in apoE ε4 non‐carriers (AUC 0.646; SE 0.035; p = 0.0001; 95 % CI 0.578–0.714) but not in ε4 carriers (AUC 0.518; SE 0.049; p = 0.719; 95 % CI 0.422–0.615). Multinomial logistic regression analysis revealed a significant (p<0.05) apoE ε4 group versus hsCRP group (<1.0 mg/L/⩾1.0 mg/L) interaction in relation to incidence of 3‐vessel CAD. In apoE ε4 non‐carriers, high hsCRP (⩾1.0 mg/L) was significantly (OR 2.1; 95 % CI 1.233–3.562; p = 0.006) associated with high incidence of 3‐vessel CAD after adjustment for major CAD risk factors. Conclusion. The diagnostic performance of hsCRP in distinguishing 3‐vessel CAD from less extensive forms of coronary atherosclerosis is more accurate in a group of subjects without the apoE ε4 allele than in patients with it.

Abstract 1675: Effect of Rosiglitazone versus Placebo on Rapid Angiographic Progression of Non-Culprit Coronary Lesions in Patients with Type 2 DM

Background: We examined the effect of 4mg/day rosiglitazone (RSG) versus placebo (PLC) on rapid angiographic progression (RAP) of non-culprit coronary lesions (NCCL) in type 2 diabetes (DM 2). Methods: Using biomarkers and angiograms from 43 DM 2 enrolled in a randomized controlled double blind trial examining the effects of RSG or PLC on late loss after PCI, we investigated the effects of RSG on RAP of NCCL using logistic regression. All stenoses &gt;=30% of vessel diameter were identified at baseline and quantified by QCA. Patients had 8 month angiography and biomarkers (HOMA (insulin resistance index), insulin, MMP-9, adiponectin (ADI), fibrinogen, hs-CRP, A1C, and LDL and HDL cholesterol) drawn at baseline and 4 months. RAP was defined as &gt;=20% diameter reduction of pre-existing NCCL by QCA, or a new narrowing &gt;=30% arising in a segment angiographically normal at baseline. Results: There were 52 NCCL in the RSG versus 56 in the PLC. 14.8 % (16/108) of lesions had RAP with 7/52 (13.5%) lesions progressing in RSG versus 9/56 (16.1%) in PLC, p=ns. RSG was not a predictor of RAP. Of the biomarkers and angiographic variables examined, hsCRP was the only predictor of RAP. Patients with a 120 day hsCRP above the 75th percent had an OR of 7.35 [2.35,23] for RAP versus those below. Interestingly, although RSG treatment lowered hsCRP at 4 months (RSG 2.03±2.8 mg/dl vs. Placebo 3.37±4.25, p=0.06), it did not decrease the likelihood of plaque progression in either the low or high hsCRP groups (see graph). LDL levels at this time were not different (RSG 74±23 mg/dl vs. PLC 89±32, p=ns). Conclusion: 120 day hsCRP is a predictor of RAP. Despite lowering 120d hsCRP, RSG did not lower the frequency of RAP.

C-reactive protein: a marker or a player?

It has been suggested that Type 2 diabetes may, in part, be precipitated or accelerated by an acute-phase reaction as part of the innate immune response, in which large amounts of cytokines are released from adipose tissue, creating a low-grade inflammatory milieu. There is also firm evidence that atherosclerosis is an immune-mediated inflammatory disease. Therefore it is reasonable to imply that low-grade inflammation is an important pathogenetic factor in atherosclerosis and cardiovascular events in patients with Type 2 diabetes. Over the last few years, there have been a lot of promising clinical markers proposed to link inflammation and atherosclerosis. Of these markers, hs-CRP (high-sensitivity C-reactive protein) might be a prognostic marker for further cardiovascular events, although this has been refuted recently. In this issue of Clinical Science, Castoldi and co-workers have demonstrated that, in patients with Type 2 diabetes categorized into low (<1.0 mg/l), medium (1.0-3.0 mg/l) and high (>3.0 mg/l) hs-CRP groups, serum levels of hs-CRP correlated with lipopolysaccharide-stimulated release of interleukin-1beta and interleukin-6 in whole blood. This finding may indicate that low-grade inflammatory activity might influence cytokine production in these patients.

HsCRP와 맥파전달시간에 대한 연구

The purpose of this study is to evaluate the relationship between high sensitive C-reactive protein (hsCRP) and pulse transit time (PPT). Apparently healthy 233 subjects had been enrolled in the health promotion center of the Pusan National University Hospital from Jan. 29 to Feb. 26, 2004. They had no previous history of diabetes, hypertension and hyperlipidemia. Subjects were categorized according to tertiles of hsCRP level [Group 1: first tertile , Group 2: second tertile , Group 3: third tertile , and Group 4: Fourth tertile ]. PTT body mass index (BMI), total cholesterol (T-C), LDL-cholesterol(LDL-C), blood sugar (BS), systolic blood pressure (sBP) and diastolic blood pressure (dBP) were significantly different among hsCRP groups (p