Association Between High-Sensitivity C-Reactive Protein and Coronary Plaque Subtypes Assessed by 64-Slice Coronary Computed Tomography Angiography in an Asymptomatic Population

Abstract

Background-Elevated levels of C-reactive protein (CRP)

High-Sensitivity C-Reactive Protein, Vascular Imaging, and Vulnerable Plaque

“…The data from Rubin et al 15 confirm and extend observations from earlier investigations that demonstrated that noncalcified lesions are more likely than calcified lesions to rupture and cause clinical events, that imaging techniques can be used to detect such lesions, and that it is these vulnerable lesions that correlate best with elevated inflammatory biomarker levels. 16 -19 The current data also directly confirm work from Hausleiter and colleagues 20 who showed in a similar, but smaller analysis of intermediate-risk individuals that those with noncalcified vulnerable plaques have significantly higher levels of hsCRP.…”

“…The use of inflammatory biomarker screening in the design of these trials will help to identify a population with a persistent inflammatory response that is most likely to benefit from antiinflammatory therapies and to exclude from randomization patients without a persistent inflammatory response and, thus, a reduced exposure risk among those least likely to benefit. As confirmed in the current study by Rubin and colleagues, 15 this biomarker screening strategy also will increase the likelihood of enrolling patients with vulnerable plaques while reducing the likelihood of enrolling those with heavily calcified lesions unlikely to rupture and less prone to sudden vessel occlusion.…”

“…In this issue of Circulation: Cardiovascular Imaging, Rubin et al 15 provide additional insight into the relationship between hsCRP levels and atherosclerosis. In a thoughtful cross-sectional evaluation of 1004 asymptomatic middleaged Korean men and women who underwent coronary CT angiography (CCTA), 21% were found to have coronary plaque despite normal blood pressure, low body mass index, and lipid levels generally considered acceptable in Western settings (average LDL cholesterol, 117 mg/dL, average highdensity lipoprotein cholesterol, 60 mg/dL).…”

“…Rubin et al 15 are careful to point out that CCTA is not an appropriate clinical tool for screening in primary prevention partly because of radiation exposure. Nonetheless, the current data have substantive clinical implications.…”

Coronary CT angiography findings based on smoking status: Do ex-smokers and never-smokers share a low probability of developing coronary atherosclerosis?

“…Smoking is known to increase an inflammatory response which is an essential component in the onset and evolution of atherosclerosis. Several studies have demonstrated a consistent relationship between CRP as a non-specific inflammatory burden indicator and cardiovascular events [28,29]. Although further study of clinical outcomes according to the smoking status is needed, our study indicates that smoking exposure could be related to the inflammatory response for atherosclerosis.…”