C-Reactive Protein Is Associated With Arterial Stiffness in Apparently Healthy Individuals

Abstract

Objective-C-reactive protein (CRP) levels predict outcome in healthy individuals and patients with atherosclerosis.Arterial stiffness also independently predicts all-cause and cardiovascular mortality and may be involved in the process of atherosclerosis. The aim of this study was to investigate the relationship between stiffness and inflammation in a cohort of healthy individuals. Methods and Results-Pulse wave velocity (PWV) and blood pressure were assessed in 427 individuals. Subjects with cardiovascular disease, diabetes, hypercholesterolemia and those using medication were excluded. CRP correlated with age, mean arterial pressure (MAP), brachial and aortic PWV, and pulse pressures. In multiple regression models, aortic PWV correlated independently with age, CRP, male gender, and MAP (R 2 ϭ0.593; PϽ0.001). CRP was also independently associated with brachial PWV. Aortic augmentation index correlated with age, gender, MAP, and inversely with heart rate and height, but not with CRP (R 2 ϭ0.794; PϽ0.001). Aortic, carotid, and brachial pulse pressures were also independently associated with CRP levels. Conclusion-Aortic and brachial PWV, and pulse pressure, relate to levels of inflammation in healthy individuals, suggesting that inflammation may be involved in arterial stiffening. Anti-inflammatory strategies may, therefore, be of benefit in reducing arterial stiffness and thus cardiovascular risk, especially in patients with premature arterial stiffening. Key Words: C-reactive protein Ⅲ pulse wave analysis Ⅲ augmentation index Ⅲ pulse wave velocity Ⅲ inflammation T he pathogenesis of atherosclerosis remains incompletely understood, but inflammation is thought to play an important role. 1 Several studies have demonstrated that serum levels of the acute phase protein, C-reactive protein (CRP), independently predict outcome in patients with cardiovascular disease 2,3 and in apparently healthy individuals. 4,5 Levels of CRP also correlate with endothelial function, an independent predictor of cardiovascular risk, 6 in patients with coronary artery disease. 7 Moreover, CRP has direct proinflammatory effects on human endothelial cells in vitro 8 and can induce endothelial dysfunction. 9 Aortic pulse wave velocity (PWV), a measure of aortic distensibility, predicts mortality in patients with end-stage renal failure, hypertension, diabetes, and older otherwise healthy individuals, independently of known confounding factors. 10 -13 Interestingly, recent evidence suggests that brachial pulse pressure, a surrogate measure of arterial stiffness, is correlated with CRP and interleukin-6 (IL-6) levels in apparently healthy men. 14,15 Moreover, an association between CRP and aortic PWV has been reported in subjects with end-stage renal failure. 16 However, whether there is any relationship between inflammation and central pulse pressure or more direct indices of arterial stiffness such as aortic PWV in healthy individuals is unclear. We hypothesized that CRP levels would be correlated with aortic PWV and central pulse pressure...

Pulse wave analysis and diabetes mellitus. A systematic review

“…In healthy individuals, after controlling for age and heart rate, both aortic and brachial PWV were associated with an elevation of the hs-CRP, while AIx was contrarily not elevated 43 . Some studies identified hs-CRP as an independent predictor of cardiovascular events, hypertension, and diabetes 44 .…”

Inflammation as Possible Mediator for the Relationship Between Lung and Arterial Function

“…Notwithstanding this controversy, CRP remains an important marker to include when investigating CVD development. Various studies report an association between CRP and PWV [10,[36][37][38] but in some, these associations disappear after adjustment for conventional risk factors for CVD [37,39,40]. There are also studies that have reported no association between CRP and PWV [41,42], and it is possible that CRP does not have a causal role in the development of arterial stiffness but may only act as a marker of vascular damage [43].…”

“…On the cardiovascular side, both of these markers were also shown to play a role in endothelial dysfunction [9] and arterial stiffening [10,11]. With arterial stiffness being one of the risk factors for CVD [12][13][14][15], it can be asserted that one of the possible mechanisms linking reduced lung function and CVD may be chronic low-grade inflammation leading to arterial stiffness.…”

Nitric oxide – the endothelium-derived relaxing factor and its role in endothelial functions

“…in vessel wall stiffening, development of atherosclerotic plaques, etc. (Ross 1993;Pasceri et al 2000;Booth et al 2004;McEniery et al 2004;Duprez et al 2005).…”