Low hs-CRP Group Research Articles

DNA methylation signatures support the role of neutrophils and monocytes in depression

IntroductionResearch repeatedly linked inflammation with major depressive disorder (MDD). The presence of an inflammatory subtype of depression is supported by molecular findings as well as imaging reports. We investigated the cell type composition estimated by using epigenome-wide DNA methylation markers in a sample of depressed individuals showing high or low inflammation levels measured by hsCRP. We aimed to understand the connection between depression and inflammation, specifically differences in cell type compositions between high and low inflammation groups at baseline.Objectives119 individuals with MDD were included for this analysis. Following quality control procedures, 113 participants were included in the analysis (Mage= 47 years, 57.98% women). The sample consisted of 37 individuals with high hsCRP (hsCRP > 1.5, Mage=45, MhsCRP=8.2, MMADRS=28, 70% women) and 76 individuals with low hsCRP (hsCRP < 1.5, Mage= 44, MhsCRP=0.99, MMADRS=28, 49% women).MethodsThe Illumina Infinium MethylationEPIC 850k BeadChip was used for analyzing whole blood derived DNA. Data processing and cell type estimation was conducted using the RnBeads package. We applied the Houseman method to estimate cell type composition through epigenome-wide DNA methylation signatures, resulting in six cell types: neutrophils, natural killer cells, B cells, CD4+ T cells, CD8+ T cells and monocytes. Comparisons between both groups were tested using ANOVA.ResultsHigh and low hsCRP groups were compared for each of the six cell types estimated. A statistically significant difference was seen for monocytes (p=0.0316) and a trend for neutrophils (p=0.0742). The mean values for neutrophils in patients without inflammation were found to be 60%, while in patients with inflammation, it was 63%. For monocytes, the mean values for patients without inflammation and those with inflammation were 10% and 9.4%, respectively, with a smaller range (4.5%-14.3%) for individuals with inflammation as compared to patients without inflammation (5.3%-20.7%). None of the other four cell types showed a statistically significant difference.Conclusions We identified differences in the cell type composition between groups of depressed patients with high versus low inflammation. These results align with the existing body of knowledge reported in established academic literature. Our study emphasizes the role of specific cells like neutrophils and monocytes in inflammation and depression. These findings offer valuable insights for improving depression treatment strategies as inflammation state may be relevant for treatment response. We also show the merit of DNA methylation signatures for the profiling of patients’ inflammation status, i.e., immunomethylomics.Disclosure of InterestNone Declared

Predictive role of pre-thrombolytic hs-CRP on the safety and efficacy of intravenous thrombolysis in acute ischemic stroke

PurposeTo investigate the predictive role of pre-thrombolytic high sensitivity C-reactive protein (hs-CRP) on the safety and efficacy of intravenous thrombolysis in patients with acute ischemic stroke (AIS).MethodsPatients with AIS who underwent intravenous thrombolysis with recombinant plasminogen activator (rtPA) or urokinase without endovascular therapy from June 2019 to June 2022 were retrospectively analysed. All patients were grouped into two groups (high or low hs-CRP group) according to the median value of hs-CRP before intravenous thrombolysis. The baseline NIHSS, NIHSS changes before and after thrombolysis (ΔNIHSS), the rate of good thrombolysis response (NIHSS decreased ≥ 2 points from baseline), the rate of any intracranial hemorrhage, age, sex, hypertension, diabetes, uric acid and platelet count were compared between the two groups. Logistic regression analysis was performed to identify possible prognostic factors for a good thrombolysis response.ResultsA total of 212 patients were included in the analysis, with a mean age of 66.3 ± 12.5 years. In total, 145 patients received rtPA, and 67 patients received urokinase. Patients were divided into a high hs-CRP group (> 1.60 mg/L) and a low hs-CRP group (≤ 1.60 mg/L) according to the median hs-CRP level (1.60 mg/L). The ΔNIHSS of the high hs-CRP group was significantly smaller than that of the low hs-CRP group (0 [-1 ~ 0] vs. -1 [-2 ~ 0], P < 0.05). The good rate of thrombolysis response in the high hs-CRP group was significantly lower than that in the low hs-CRP group (21.9% vs. 36.5%, P < 0.05). Similar results were shown in the rtPA subgroup between the high and low hs-CRP groups but not in the urokinase subgroup. Logistic regression analysis showed that hs-CRP > 1.60 mg/L was negatively correlated with a good thrombolysis response rate (OR = 0.496, 95% CI = 0.266–0.927, P = 0.028).Conclusionhs-CRP > 1.6 mg/L may serve as a poor prognosis predictive factor for patients with AIS receiving intravenous thrombolysis. However, due to the small sample size of this study, further studies are needed to verify our results.

Role of High-Sensitivity C-reactive Protein Levels in Predicting the Risk of Six-Month Event Rates in Patients With Chronic Stable Angina Undergoing Percutaneous Transluminal Coronary Angioplasty With a Drug-Eluting Stent.

Introduction This prospective observational study reports the association between baseline high-sensitivity C-reactive protein (hs-CRP) levels and adverse events at six months in patients who were diagnosed with symptomatic chronic stable angina and then underwent percutaneous transluminal coronary angioplasty (PTCA) with a drug-eluting stent (DES). Methods A total of 104 patients were examined with chronic stable angina over a period of six months. Before conducting percutaneous coronary intervention (PCI), the baseline levels of hs-CRP were measured, and based on the levels, the patients were grouped into high and low hs-CRP groups. Results The primary causes of death or the need for repeat revascularization or myocardial infarction or angina were concluded after assessing the patients for six months. A total of 104 patients were studied, amongwhich 72 (69.23%) had low hs-CRP and 32 (30.77%) had high hs-CRP levels. The number of males in this study was 68 (65.38%) and females were 36 (34.62%). The mean age of the patients was 55.26 ± 10.31 years. There were no significant differences among the groups in terms of gender, age, comorbidities, and risk factors except for certain predisposing factors like dyslipidemia and smoking. Moreover, we did not find any significant difference amongthe groups in the cause of death and myocardial infarction after a follow-up of six months. However, we observed a higher need for revascularization and angina outcomes in the group with high hs-CRP compared to low hs-CRP. Conclusion It can be concluded that a higher risk of angina and repeat revascularization is related to a high baseline hs-CRP but there is no evidence whether it is somehow linked to myocardial infarction and mortality or not.

Predictive value of high sensitivity C-reactive protein in three-vessel disease patients with and without type 2 diabetes

BackgroundDiabetes mellitus (DM) and atherosclerosis are multifactorial conditions and share a common inflammatory basis. Three-vessel disease (TVD) represents a major challenge for coronary intervention. Nonetheless, the predictive value of high-sensitivity C-reactive protein (hs-CRP) for TVD patients with or without type 2 DM remains unknown. Herein, we aimed to ascertain the long-term predictive value of hs-CRP in TVD patients according to type 2 DM status from a large cohort.MethodsA total of 2734 TVD patients with (n = 1040, 38%) and without (n = 1694, 62%) type 2 diabetes were stratified based on the hs-CRP (< 2 mg/L vs. ≥ 2 mg/L). Three multivariable analysis models were performed to evaluate the effect of potential confounders on the relationship between hs-CRP level and clinical outcomes. The Concordance index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess the added effect of hs-CRP and the baseline model with established risk factors on the discrimination of clinical outcomes. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE).ResultsThe median follow-up duration was 2.4 years. Multivariate Cox regression analyses showed that the incidence of MACCE (adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.01–1.35, p = 0.031) and all-cause death (HR 1.82, 95% CI 1.07–3.11, p = 0.026) were significantly higher in the diabetic group compared to the non-diabetic group. In the diabetic group, the incidence of MACCE (adjusted HR 1.51, 95% CI 1.09–2.10, p = 0.013) was significantly higher in the high hs-CRP group than in the low hs-CRP group; no significant difference was found for all-cause death (HR 1.63; 95% CI 0.58–4.58, p = 0.349). In the non-diabetic group, the prevalence of MACCE (adjusted HR 0.93, 95% CI 0.71–1.22, p = 0.613) was comparable between the two groups. Finally, the NRI (0.2074, p = 0.001) and IDI (0.0086, p = 0.003) for MACCE were also significantly increased after hs-CRP was added to the baseline model in the diabetic group.ConclusionsElevated hs-CRP is an independent prognostic factor for long-term outcomes of MACCE in TVD patients with type 2 diabetes but not in those without type 2 diabetes. Compared to traditional risk factors, hs-CRP improved the risk prediction of adverse cardiovascular events in TVD patients with type 2 diabetes.

Serum C-reactive protein levels are associated with clinical pregnancy rate after in vitro fertilization among normal-weight women.

To assess whether low-grade inflammation, measured by serum high-sensitivity C-reactive protein (hsCRP) levels, is associated with in vitro fertilization (IVF) outcomes. A retrospective study. University-affiliated IVF center. In the present study, 875 women of normal weight who underwent their first fresh embryo transfer (ET) cycles for IVF treatment were divided into three groups according to serum concentrations of hsCRP. Serum from women undergoing IVF was collected on days 2-4 of a spontaneous menstrual cycle prior to the commencement of ovarian stimulation. The IVF outcomes included implantation, biochemical pregnancy, clinical pregnancy, miscarriage and live birth rates. The women were divided into three groups according to the baseline serum levels of hsCRP as follows: low hsCRP (<1 mg/L; n=517), medium hsCRP (1-3 mg/L; n= 270), high hsCRP (>3 mg/L; n=88). The maternal age was similar among the three groups. The women in the high and medium hsCRP group had significantly higher BMI compared with those in the low hsCRP group. The protocol of controlled ovarian hyperstimulation, the gonadotropin dose administered, the serum estradiol levels, progesterone levels and the endometrial thickness on the day of triggering, as well as the number of retrieved oocytes, fertilized oocytes and good quality embryos, and the oocyte maturation rate were similar among the three groups. Implantation, biochemical pregnancy and clinical miscarriage rates did not differ significantly were not significantly different among three groups. The clinical pregnancy rate was significantly lower in the high hsCRP group compared with that in the low hsCRP group (50.0% versus 63.4%; P<0.0167), which contributed to a significant decrease in birth rate (39.8% versus 53.8%; P<0.0167). High serum hsCRP levels was found to be a factor affecting live birth rate. Among women of normal weight undergoing their first IVF treatment, it was found that low-grade inflammation was associated with reduced clinical pregnancy and live birth rates following fresh ET cycles.

Elevated HsCRP in Chronic Obstructive Pulmonary Disease: A Prospective Study of Long-Term Outcomes After Percutaneous Coronary Intervention.

ObjectiveAnti-inflammatory therapies are reported to have additional benefits beyond lipid control for patients with cardiovascular disease. However, no study has focused on the relationship between inflammation status and long-term outcomes for chronic obstructive pulmonary disease (COPD) patients, after percutaneous coronary intervention (PCI).Methods277 COPD-PCI patients were divided into two groups according to hsCRP status upon admission. Major adverse cardiac events (MACE) in high hsCRP patients were compared to patients with low hsCRP. Restricted cubic spline (RCS) analysis was performed using MACE hazard ratios (HR) to investigate interrelations with hsCRP, as a continuous variable.ResultsPatients in the high hsCRP group incurred more inflammation activation, in terms of higher white blood cell counts, neutrophil, lymphocytes, and had higher smoking rates, compared to those with lower hsCRPs. A significant increase in MACEs was observed in hsCRP high group, compared to the low hsCRP group (HR: 2.47, 95% CI: 1.22–5.00; p = 0.012). RCS curves suggest that HRs rise beyond 1.0, after the 0.24 juncture for Lg HsCRP (base 10 logarithm with hsCRP), HR per SD: 1.19 (95% CI: 0.96–1.48). Further subgroup analysis implies that elevated hsCRP is associated with a higher risk of MACEs across the sub-groups tested.ConclusionHsCRP could be a useful indicator for COPD-CAD patient prognosis, after PCI. This is because hsCRP highlights inflammation activation. More multi-center research, designed for COPD-CAD patients should be conducted to more accurately determine the cut-off value for hsCRP.

Relation of CRP gene variants to altered risk of Helicobacter pylori - associated chronic gastritis: A case-control study in Tunisia

BackgroundWe investigated the association between CRP variants and chronic gastritis in H. pylori-infected patients at the allele, genotype, and haplotype levels. This was also assessed according to serum hs-CRP levels. MethodsStudy subjects consisted of 77 H. pylori-infected patients and 96 H. pylori-negative controls. Genotyping of the CRP rs1572970, rs876537, rs2794520, rs2808630, rs1130864, rs1417938, rs7553007, and rs4285692 variants were analyzed by real-time PCR. ResultsSignificantly higher MAF and increased risk of chronic gastritis were associated with rs1130864, rs1417938, and rs7553007, which persisted after controlling for key covariates. Significant differences in the genotype distribution of rs1130864, rs1417938, and rs7553007 were also seen between H. pylori-infected patients and healthy controls. Increased risk of H. pylori-associated chronic gastritis was associated with carriage of rs1130864 C/T, and more with T/T genotype carriers, as well as with rs1417938 T/A and A/A genotype carriers. Functionally, the distribution of rs1130864 and rs1417938 genotypes were significantly different between H. pylori-infected patients and controls in the low hs-CRP (<6 mg/L) group. CRP haplotype analysis identified Block 1 (rs1572970, rs876537, rs2794520), and Block 2 (rs2808630, rs1130864, rs1417938) associated with H. pylori infection. Haplotypes ACC (Block 1) and TTA and TTT (Block 2) were positively associated with H. pylori-associated chronic gastritis with low hs-CRP levels. ConclusionAltered serum levels of hs-CRP, stemming in part from the presence of specific genetic variants in CRP gene, modulate the risk of H. pylori infection.

Abstract 12370: Prognostic Value of Inflammatory Markers in Recurrent Pericarditis

Background: Expert guidelines recommended the use of inflammatory markers for the confirmatory diagnosis of recurrent pericarditis (RP), however the prognostic role in management is unknown. Inflammatory marker levels in RP fluctuate, therefore measurement during flare is paramount. We attempt to assess the prognostic value of inflammatory markers (ESR, hs-CRP) taken during active flare in idiopathic/viral RP. Methods: We retrospectively reviewed 130 patients with established RP from 2015 to 2019 with inflammatory markers during flare. RP was diagnosed if two of these features were present; pleuritic chest pain, EKG changes, rub, and effusion. Active flare was defined as pleuritic chest pain with raised inflammatory markers. Clinical improvement (CI) and remission (CR) were assessed. CI was defined as symptom improvement on dual anti-inflammatory therapy. CR was established with symptom resolution and cessation of therapy. Results: Mean age was 46 ± 16, 57% were female, and a median number of recurrences was 3. The median follow-up time was 633 days, and median time to first recurrence was 263 days. Patients with lower hs-CRP &lt;10 mg/L were more likely to have CI as compared to the higher hs-CRP ≥10 mg/L group (79% vs 42%, p=0.012). Also, patients in the lower hs-CRP group showed a higher tendency to achieve CR (43% vs 20%, p = 0.081). ESR was statistically insignificant for the outcomes. The median time to CI in the low hs-CRP group was less compared to the high hs-CRP group (11 vs. 32 months). Majority of high hs-CRP patients did not achieve CR. The probability of CI and CR among low hs-CRP is higher as compared to high hs-CRP (log-rank p=0.001; log-rank p=0.034) [Figure 1]. Conclusion: Patients who had higher hs-CRP were less likely and required more time to achieve CI and CR as compared to patients with lower hs-CRP. This highlights the prognostic significance of hs-CRP that may assist management of RP even without a concurrent ESR level. Figure 1: Kaplan-Meier Analysis of CI and CR

Association of triglyceride-glucose index and high-sensitivity C-reactive protein with asymptomatic intracranial arterial stenosis: A cross-sectional study

Background and aimsTriglyceride-glucose index (TyG) and high-sensitivity C-reactive protein (hsCRP) have been shown to play important roles in the pathophysiological mechanisms of atherogenesis. However, the cumulative value of TyG and hsCRP in identifying asymptomatic intracranial arterial stenosis (aICAS), as well as its severity and numerical burden, is uncertain. This study seeks to fill this knowledge gap. Methods and resultsThis study included 1938 participants aged ≥40 years who were free of stroke or transient ischemic attack. All participants were classified into four groups based on the participants’ TyG and hsCRP levels, including low-TyG and low-hsCRP, low-TyG and high-hsCRP, high-TyG and low-hsCRP, and high-TyG and high-hsCRP groups. The presence of aICAS was screened via transcranial Doppler ultrasound and confirmed by magnetic resonance angiography. The TyG was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. We used multinomial logistic regression analysis to investigate the cumulative value of TyG and hsCRP on identifying the severity of aICAS or its numerical burden. After adjustment for conventional confounders, isolated high-hsCRP, isolated high-TyG, and high-TyG combined with high-hsCRP were independently associated with moderate-to-severe aICAS. Compared with the low-TyG and low-hsCRP group, participants with high-TyG and high-hsCRP had a 2.6 times higher odds ratio (OR) of having a single moderate-to-severe aICAS and a 3.3 times higher OR of having multiple moderate-to-severe aICASs. ConclusionThe cumulative value of TyG and hsCRP may better identify moderate-to-severe aICAS as well as its numerical burden.

Relationship Between High-Sensitivity C-Reactive Protein and Long-Term Outcomes in Elderly Patients With 3-Vessel Disease.

The prognostic value of high-sensitivity C-reactive protein (hsCRP) in complex coronary artery disease has not been fully established. We aimed to determine the association between hsCRP and long-term outcomes in elderly patients with 3-vessel disease (TVD). From April 2004 to February 2011, 3069 patients aged ≥65 years with TVD were consecutively enrolled and received medical treatment alone, percutaneous coronary intervention, or coronary artery bypass grafting. The patients were divided into 2 groups according to their hsCRP levels: <3.00 mg/L (62.1%) and ≥3.00 mg/L (37.9%). The mean age was 71 ± 4 years. The high hsCRP group had more risk factors and more frequently received conservative treatment than the low hsCRP group. During a median follow-up period of 6.2 years, elevated hsCRP was significantly associated with increased all-cause death (19.5% vs 29.6%, P < .001), cardiac death (9.4% vs 15.2%, P = .001), and major adverse cardiovascular and cerebrovascular events (34.1% vs 42.5%, P = .001). Multivariable Cox regression analyses revealed that hsCRP was an independent predictor for all of these events. Combining hsCRP with Synergy between PCI with TAXUS and Cardiac Surgery score II further improved the predictive power of the score. The relationship between hsCRP and mortality was relatively consistent across subgroups. Overall, hsCRP could prove useful for risk prediction in elderly patients.

Combination of Highly Sensitive C-Reactive Protein with R-ISS Is a Novel and Powerful Staging System in Multiple Myeloma

Introduction: Multiple myeloma (MM) is a hematological malignancy characterized by proliferation of abnormal plasma cells in bone marrow. Revised-International Staging System (R-ISS) is generally used as a predictor in newly diagnosed MM (NDMM) since 2015. R-ISS combines ISS with chromosomal abnormalities (CA) and serum lactate dehydrogenase (LDH). R-ISS I is defined as ISS I without high risk CA and normal LDH, R-ISS III is defined as ISS III with high risk CA or high level LDH, and R-ISS II includes all of the other possible combinations. Therefore, about 60% of NDMM are classified to R-ISS II. However, MM is a highly heterogeneous disease, so the clinical outcome of MM with R-ISS II also must be heterogeneous. Therefore, factors stratifying the majority of MM is needed. C-reactive protein (CRP) is a commonly used inflammatory marker. In particular, highly sensitive (hs) CRP detects lower concentration of CRP as compared with the conventional method, and has been reported to be associated with mortality of lung, breast, and renal cell cancers. In this study, we evaluated the predicting potential of hs-CRP in MM in the novel agent era to see if hs-CRP can develop the stratifying power of R-ISS. Materials and Methods: The retrospective study examined 80 patients with symptomatic NDMM who had been diagnosed at our institution between April 2006 and September 2019. Patients with infection and/or amyloidosis were excluded. Linkable anonymizing data, including age, gender, immunoglobulin type, symptoms, R-ISS, hs-CRP at diagnosis, time to next treatment (TNT) of the initial treatment, and overall survival (OS) were collected. The concentration of hs-CRP was measured by quantitative latex agglutination turbidimetric immunoassay. The lower detection limit of hs-CRP is 0.01 mg/dL, while that of conventional CRP was 0.10 mg/dL. We analyzed these data using the Kaplan-Meier method, Fisher's exact, multivariate cox proportional hazard models, and log-rank test. P-values ≤0.05 was considered to be statistically significant. This retrospective study was approved by institutional review board in University of Fukui, Japan (No. 20190101). Results: Among 80 patients, 39 (48.8%) were male. Median age at diagnosis was 71 years (range: 36-89 years). IgG, IgA, and BJP types were 56.8%, 25.9%, and 17.3%, respectively. Median follow-up was 29 months (range: 1-120 months). All of the patients were treated with bortezomib and/or lenalidomide-based regimens throughout their clinical courses. R-ISS I, II, and III were 7.3%, 76.4%, and 16.4%, and median OS in patients with R-ISS I, II, and III were unreached, 67, and 15 months, respectively (p&amp;lt;0.0001). Median hs-CRP was 0.10 mg/dL (range: 0.01-8.86 mg/dL), and the patients were divided into 2 groups according to median hs-CRP, consisting of low hs-CRP group (≤0.1 mg/dL, n=42) and high hs-CRP groups (&amp;gt;0.1 mg/dL, n=38). No significant difference in gender, age, immunoglobulin type was observed between 2 groups according to Fisher's exact test. The levels of hs-CRP appeared to be associated with the presence of bone lesions, not hypercalcemia, renal dysfunction, and anemia. There was not significant correlation between hs-CRP and TNT of the initial treatment, due to the variation of the used regimens. However, Kaplan-Meier curves showed that low hs-CRP group had significantly better OS than high hs-CRP group (64 months vs. 54 months, p=0.0116). Multivariate analysis indicated that both R-ISS (hazard ration (HR), 6.19) and hs-CRP (HR, 7.03) were independent prognostic factors for OS. Moreover, comparing the patients with R-ISS II divided by median hs-CRP, OS was significantly longer in R-ISS II with low hs-CRP than R-ISS II with high hs-CRP (median OS: 81 months vs. 54 months, p=0.0009) (Figure 1). Similarly, in the patients with R-ISS III, OS tended to be longer in low hs-CRP group than high hs-CRP group (median OS: 21 months vs. 5.5 months). All the patients with R-ISS I survived within the follow-up period. Conclusions: Hs-CRP enabled to detect 0.01-0.1 mg/dL, that is not measured by the conventional CRP method. The superiority of hs-CRP contributes to the role as a powerful predictor in MM. The novel staging system that combines hs-CRP and R-ISS may establish better understanding of prognosis in NDMM. Disclosures Yamauchi: Pfizer: Honoraria, Research Funding; Otsuka: Research Funding; Chugai: Honoraria; Abbie: Research Funding; Solasia Pharma: Research Funding; Daiichi Sankyo: Research Funding; Ono Pharmaceutical: Honoraria; Astellas: Research Funding.

Sex differences in the association between self-rated health and high-sensitivity C-reactive protein levels in Koreans: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey

BackgroundNo studies have investigated the association between self-rated health (SRH) and high-sensitivity C-reactive protein (hs-CRP) levels in South Koreans. We explored this association and analyzed differences between sexes.MethodsUsing cross-sectional data from the 2015–2017 Korea National Health and Nutrition Examination Survey, we analyzed the association between SRH and high hs-CRP levels (> 1.0 mg/L) in 14,544 Koreans aged ≥ 19 years who responded to the SRH survey and had available hs-CRP test results. Differences in sociodemographic factors were analyzed using the Pearson’s chi-square test for categorical variables or the Mann–Whitney U test for continuous variables. Multiple logistic regression analysis was used to measure the association between hs-CRP levels and SRH according to sex while adjusting for other possible confounders.ResultsThe percentage of very poor to poor SRH was higher in the high hs-CRP group (22.4%) than in the low hs-CRP group (17.66%). Among men, the risk of a high hs-CRP level increased with worse SRH (adjusted for confounders; P for trend < 0.001). After adjusting for all confounders, including chronic diseases, men with very poor SRH showed a higher odds ratio (OR) for high hs-CRP levels than those with very good SRH (fully adjusted OR, 1.74; 95% CI, 1.04–2.90). Significant correlations were absent among women.ConclusionsPoor SRH was correlated with low-grade inflammation (high hs-CRP levels) among Korean male adults. These findings could be useful for developing health improvement programs and in goal setting at a national scale.

Relationship between high sensitivity C-reactive protein and angiographic severity of coronary artery disease.

BackgroundCoronary artery disease (CAD) remains a leading cause of morbidity and mortality. Cytokines play a potential role in atherosclerosis pathogenesis and progression. We investigated the association between high sensitive C-reactive protein (hsCRP) and severity of CAD.MethodsCAD patients were stratified according to hsCRP cut-off value into high levels hsCRP group (≥ 8.4 mg/L) and low levels hsCRP group (< 8.4 mg/L). Severity of CAD was assessed according to artery stenosis degree and the number of vessel involved. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 23.0).ResultsThe mean age was 60.3 ± 11.0 years. The level of hsCRP was increased and ranged from 0.2 to 1020.0 mg/L. Biochemical risk factors and severity of CAD didn't show significant differences between the two groups. In multivariate linear analysis, cardiac troponin I (cTnI) and serum amyloid A (SAA) were predictors of hsCRP. As shown in receiver operating characteristic (ROC) curve analysis performed in patients with ST-segment elevation myocardial infarction (STEMI) and compared to myonecrosis biomarkers, hsCRP (area under the curve (AUC): 0.905; 95%CI: 0.844–0.966; P < 0.001) could be a powerful predictor marker in evaluating the infarct size after myocardial infarction but not better than cTnI.ConclusionsHsCRP levels were not associated with the severity of CAD but could be useful in the evaluation of myocardial necrosis in patients with STEMI.

Association of high sensitivity C-reactive protein and metabolic syndrome components in middle-aged subjects without overt cardiovascular disease in LitHiR primary prevention programme

Summary Objectives: Circulating levels of inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) have been reported to be associated with increased risk of cardiovascular disease (CVD), as well as with metabolic syndrome (MetS). Therefore, our objectives were to investigate the associations between hs-CRP levels and individual MetS components as well as to analyse if hs-CRP levels are linked with the number of MetS components present in middle-aged subjects. Design and methods: A cross-sectional study included 4628 middle-aged MetS subjects from the Lithuanian High Cardiovascular Risk primary prevention programme (LitHiR) from 2011 to 2020. MetS was diagnosed according to the National Cholesterol Education Program ATP III modified criteria. CRP was measured by a validated high-sensitivity assay. A hs-CRP cutpoint of 5 mg/l was used to differentiate high and low hs-CRP groups. Results: The mean value of hs-CRP was 3.23 ± 4.04 mg/l, and significantly increased as the number of components of MetS increased (p &lt; 0.001). The concentration of serum hs-CRP was significantly associated with waist circumference, systolic and diastolic blood pressure, and fasting blood glucose (all p &lt; 0.001). However, no statistically significant associations were found between hs-CRP and serum triglycerides (p = 0.340) or serum high-density lipoprotein cholesterol (p = 0.148). Conclusions: Serum hs-CRP increased progressively with increased waist circumference, blood pressure, fasting blood glucose in middle-aged subjects with MetS. The higher values of hs-CRP were more often present in obese subjects and women. The incremental rise in mean serum hs-CRP level was found with an increasing number of MetS components.

High high-sensitivity C-reactive protein/BMI ratio predicts future adverse outcomes in patients with acute coronary syndrome.

The prognostic value of high-sensitivity C-reactive protein (hsCRP) and obesity in patients with coronary artery disease is controversial. In previous studies, hsCRP was significantly associated with BMI. Thus, we integrated hsCRP and BMI to assess the predictive value in patients with acute coronary syndrome (ACS). In this observational cohort study, 478 patients with ACS were enrolled in Fuwai Hospital from 2010 to 2011,with a mean follow-up of 4.2 years. The endpoint of major adverse cardiovascular events (MACE) was the composite of cardiovascular death, myocardial infarction, revascularization again, heart failure, or stroke. Compared with patients without MACE, we found that patients with MACE had higher hsCRP (3.86 ± 3.66 vs. 3.00 ± 3.17, P = 0.033). Furthermore, we identified that hsCRP was significantly correlated with BMI (r = 0.134, P = 0.005). Thus, hsCRP level was adjusted by BMI to further clarify its role in the prognosis of patients with ACS. According to the tertiles of hsCRP/BMI ratio, the rates of MACE in the lowest tertile group, the median tertile group, and the highest tertile group were 14.0% (21/150), 14.0% (21/150), and 26% (39/150) (P = 0.008), respectively. In multivariate analysis, hsCRP/BMI was independently and positively related to MACE. Similarly, according to risk category of hsCRP (low hsCRP group < 3.0 mg/l, high hsCRP group ≥ 3.0 mg/l) and BMI (< 24 and ≥ 24.0 kg/m), patients in the high hsCRP but normal or low weight group had the lowest MACE-free survival (log-rank P = 0.003) compared with other groups. We confirmed that C-reactive protein level should be adjusted by BMI to reflect the prognosis of patients with ACS. High hsCRP/BMI ratio was associated with adverse outcomes. Patients with ACS with high hsCRP plus overweight had the same risk for MACE as those with lower hsCRP but normal weight.

C-reactive protein variability is associated with vascular access outcome in hemodialysis patients.

Hemodialysis (HD) vascular access failure is one of the most important causes of morbidity and contributes to the cost of dialysis care. There is paucity of data evaluating long-term monitoring of C-reactive protein (CRP) on outcome of HD vascular access. We conducted a retrospective study to investigate whether variability of serum CRP level was associated with vascular access failure rate over a 7-year period. A total of 318 HD patients were included. Their demographic data, co-morbidities and biochemical data were reviewed and collected. Serum high-sensitivity CRP (hs-CRP) level was measured every 6months. Patients were divided into three groups according to their serial hs-CRP levels. Patients with their hs-CRP below 2mg/L were defined as low group (n=65, 20.4%) and those with higher than 4mg/L were defined as high (n=39, 12.3%). The rest were classified as fluctuated hs-CRP group (n=214, 67.3%). Treatment of vascular access failure includes angioplasty and access re-creation. Their body mass index, indicators of dialysis adequacy and serum albumin and hs-CRP levels differed significantly among three groups. The annual vascular access failure rate was significantly higher in fluctuated hs-CRP group than in high hs-CRP group (0.41 vs 0.36, P=.037). Serum albumin was a significant associate of vascular access failure. Kaplan-Meier survival analysis indicated patients with high or fluctuated hs-CRP had shorter free interval of vascular access failure than low hs-CRP group. HD patients with fluctuated hs-CRP levels were associated with increased vascular access failure.

Association between adherence to dietary recommendations and high-sensitivity C-reactive protein level in type 1 diabetes.

Inflammation plays an important role in the pathogenesis of cardiovascular diseases. Diet, as a modifiable risk factor, may in turn impact systemic inflammation. We therefore assessed whether adherence to the dietary recommendations is associated with high-sensitivity C-reactive protein (hs-CRP) concentrations in type 1 diabetes. Cross-sectional data from 677 FinnDiane study participants (48% men, mean±standard deviation age 46±13years) were included. Dietary intake was assessed with a self-administered questionnaire. A diet score, with higher values denoting better adherence to the recommendations, was calculated. Serum hs-CRP concentration was measured, and individuals with hs-CRP <1.0mg/l, and hs-CRP >3.0 but ≤10.0mg/l were compared. Men and women with high hs-CRP had higher BMI, waist circumference, and triglyceride concentration, but lower HDL-cholesterol concentration. Adjusted for BMI, mean diet score was higher in the low hs-CRP group, both in men (10.8±3.6 vs. 9.9±3.8, p=0.023) and women (12.7±3.4 vs. 11.6±3.5, p=0.021). After further adjustments with potential confounding factors, the difference remained significant only in men. A diet that more closely adheres to the dietary recommendations is associated with lower hs-CRP in men. A prudent diet may help reduce systemic inflammation in type 1 diabetes.

Prognostic Significance of Plasma High-Sensitivity C-Reactive Protein in Patients With Hypertrophic Cardiomyopathy.

BackgroundElevated high‐sensitivity C‐reactive protein (hsCRP) has been associated with increased risks of adverse outcomes of various cardiovascular diseases. The relationship between hsCRP and the prognosis of hypertrophic cardiomyopathy remains to be evaluated.Methods and ResultsThe study used an observational cohort methodology. A total of 490 patients were enrolled in the Fuwai Hospital from 2001 to 2011 and were followed for 3.7±2.0 years. According to the risk category of hsCRP, subjects in the high hsCRP group (>3.0 mg/L) had a higher risk of developing adverse events than the low hsCRP group (<1.0 mg/L): cardiovascular death (adjusted hazard ratios[HR] 5.41, 95% CI 1.96–14.93, P=0.001), all‐cause mortality (adjusted HR 4.78, 95% CI 1.99–11.47, P<0.001), sudden cardiac death (adjusted HR 11.29, 95% CI 1.38–92.20, P=0.024), and heart failure–related death (adjusted HR 4.38, 95% CI 1.15–16.60, P=0.030). Similarly, the continuous variable of hsCRP was also an independent predictor for adverse outcomes: cardiovascular death (adjusted HR 1.15, 95% CI 1.06–1.25, P=0.001), all‐cause mortality (adjusted HR 1.17, 95% CI 1.09–1.26, P<0.001), sudden cardiac death (adjusted HR 1.20, 95% CI 1.06–1.36, P=0.003), and heart failure–related death (adjusted HR 1.15, 95% CI 1.02–1.30, P=0.020).ConclusionsOur results indicate that elevated plasma hsCRP is associated with increased risk for adverse outcomes in patients with hypertrophic cardiomyopathy.

High-sensitivity C-reactive protein and mean platelet volume as predictive values after percutaneous coronary intervention for long-term clinical outcomes: a comparable and additive study.

This study was designed to establish the relationship of high-sensitivity C-reactive protein (hsCRP) and mean platelet volume (MPV) with the development of adverse outcomes after percutaneous coronary intervention (PCI). hsCRP levels and MPV were analysed in 372 patients who underwent PCI, with the primary endpoint as major adverse cardiac and cerebrovascular events (MACCE): a composite of cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), ischemic stroke and stent thrombosis. During the follow-up period (mean, 25.8 months), there were 21 cardiac deaths, 10 MIs including four stent thrombosis events, seven ischemic strokes and 29 TVRs. The hsCRP cut-off level was set at 0.31 mg/dl using the receiver operating characteristic curve to differentiate between the groups with and without MACCE. The MPV cut-off level was set at 8.00 fl by the receiver operating characteristic curve to differentiate between the groups with and without MACCE. A Kaplan-Meier analysis revealed that the high hsCRP group (≥0.31 mg/dl) had a significantly higher cardiac death and MACCE rate than the low hsCRP group (<0.31 mg/dl), and the high MPV group (>8.00 fl) had a significantly higher cardiac death and MACCE rate than the low MPV group (≤8.00 fl). Furthermore, the high hsCRP and MPV groups were significantly associated with an increased risk of MACCE. These results show that hsCRP and MPV are predictive markers after PCI for MACCE; they are also additively associated with a higher risk of MACCE.

Chronic Subclinical Inflammation in Middle Aged Bangladeshi Population: Association with Low High-density Lipoprotein Cholesterol

Aim: The present study was undertaken to investigate the association of chronic subclinical inflammation as assessed by high sensitivity C-reactive protein (hsCRP) with high-density lipoprotein (HDL) cholesterol in a middle aged Bangladeshi population. Materials and Methods: Total 348 adults (169 male, 179 female) were included and anthropometric data and clinical histories were recorded. Serum lipids were measured by enzymatic endpoint technique and hsCRP was estimated by immunoturbidimetric method. Results: The mean of age and body mass index (BMI) of the total subjects were 50.5 ± 11.5 years and 26.7 ± 4.5 kg/m2 respectively. Substantial proportions (57.47%) of the subjects had low HDL cholesterol. Of the total subjects, 45.4% had hsCRP > 3.0 mg/l followed by 31.9% with hsCRP: 1.0-3.0 mg/l coupled with elevation of one or more traditional risk factors of CVDs. Lipid parameters showed no significant difference between subjects with low and moderate (hsCRP ≤3.0 mg/l) and high hsCRP (hsCRP > 3.0 mg/l). But BMI was significantly higher in high hsCRP group compared to low hsCRP group [25.4 (23.3-27.9) vs 27.3 (24.3-30.1) kg/m2, p