Association Between Obesity, High-Sensitivity C-Reactive Protein ≥2 mg/L, and Subclinical Atherosclerosis

Abstract

Objective High-sensitivity C-reactive protein (hsCRP) levels are closely associated with abdominal obesity, metabolic syndrome, and atherosclerotic cardiovascular disease. The JUPITER trial has encouraged using hsCRP ≥2 mg/L to guide statin therapy; however the association of hsCRP to atherosclerosis, independent of obesity, remains unknown. Methods and Results We studied 6,760 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). Participants were stratified into 4 groups: non-obese/low hsCRP, non-obese/high hsCRP, obese/low hsCRP, and obese/high hsCRP. Using multivariable logistic and robust linear regression, we described the association with subclinical atherosclerosis, using coronary artery calcium (CAC) and carotid intima-media thickness (cIMT). Mean BMI was 28.3 ± 5.5 kg/m2, and median hsCRP was 1.9 mg/L (0.84 – 4.26). High hsCRP, in the absence of obesity, was not associated with CAC and was mildly associated with cIMT. Obesity was strongly associated with CAC and cIMT independent of hsCRP. When obesity and high hsCRP were both present, there was no evidence of multiplicative interaction. Similar associations were seen among 2,083 JUPITER-eligible individuals. Conclusions High hsCRP, as defined by JUPITER, was not associated with CAC and was mildly associated with cIMT in the absence of obesity. In contrast, obesity was associated with both measures of subclinical atherosclerosis independent of hsCRP status.

Assessment of coronary artery disease using coronary computed tomography angiography and biochemical markers

“…However, further basic science research has questioned a direct atherogenic mechanism [66,67] . Others and we could show that serum levels of hsCRP are only weakly correlated with plaque composition and coronary artery calcification and largely determined by the presence of risk factors [58,68,69] . More specific markers of inflammation could provide a stronger association with plaque formation and atherosclerotic inflammation.…”

“…MDCT 124 hsTnT is associated with the extend of positive remodeled NCP. Only weak association was detected for hsCRP Blaha et al [68] hsCRP 4-sl. MDCT 6762 hsCRP was not associated with coronary artery calcification Duivenvoorden et al [70] hsCRP, MPO, and others 18 FDG-PET/CT 130 MPO levels are associated with carotid plaque inflammation Andrassy et al [62] HMBG-1 256-sl.…”

Incorporating biomarkers into clinical trials in cardiovascular medicine

“…In the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial, the study established that the use of statins in patients with low LDL still provide significant mortality benefit among patients with elevated hs-CRP (2 mg/L). 12 However, the study was criticized for not having a low hs-CRP group, and therefore not being able to determine whether hs-CRP levels contributed to the observed effect of rosuvastatin. 13 Furthermore, post hoc analysis of the study data was not able to detect any correlation between hs-CRP levels and statin response.…”

Valor prognóstico da espessura médio-intimal da artéria carótida na mortalidade de curto e longo prazo na estratégia de registro de síndrome coronariana aguda (ERICO)

“…Este é o resultado de interações complexas entre fatores genéticos e ambientais que induzem a parede arterial a responder estímulos através da ação do endotélio, das células musculares lisas, das células inflamatórias e das plaquetas levando à formação de placas. As fases iniciais podem ocorrer entre as crianças e os jovens e são silenciosos e sua evolução se dá lentamente e manifestações clínicas geralmente aparecem quando os indivíduos alcançam a meia idade (Blaha et al, 2011). No entanto, o primeiro evento provocado pela aterosclerose pode ser fatal.…”

“…Duncan et al (1997) (Mancini et al, 2004). As principais conclusões resultantes deste estudo foram apoiadas por outras investigações Introdução -15 independentes que revelam que a EMIC superior a 0,9-1,0 mm indica uma potencial doença aterosclerótica, que se traduz num aumento de riscos cardiovasculares (Blaha et al, 2011).…”