Elevated C-Reactive Protein Constitutes an Independent Predictor of Advanced Carotid Plaques in Dyslipidemic Subjects

Abstract

Abstract-Inflammation plays a key role in the physiopathology of atherosclerosis. C-reactive protein (CRP) has been found to predict cardiac events in healthy subjects and in patients with coronary heart disease. However, the relationship between CRP and subclinical atherosclerosis is not well established. We examined the potential relationship between CRP and common carotid artery intima-media thickness and carotid plaques in dyslipidemic subjects. Dyslipidemic patients (nϭ1051) were recruited for the study. All patients had a complete clinical examination and systematically underwent ultrasonographic evaluation of the extracranial carotid arteries on a duplex system. The serum concentration of CRP was measured by using a sensitive immunoradiometric assay. In a univariate model, a strong positive relationship was found between CRP and the severity of carotid stenosis (PϽ0.0001). In multivariate analysis, the association between CRP and the degree of carotid atherosclerosis remained significant for advanced plaques (Pϭ0.0007) in male subjects only. Significant correlations were found between CRP and body mass index (PϽ0.0001) and between CRP and other markers associated with the metabolic syndrome. In this large dyslipidemic population, elevated CRP is an independent predictor of advanced carotid plaques in male subjects. Body mass index and other markers of the metabolic syndrome (HDL cholesterol, triglycerides, diabetes, and high blood pressure) are significant determinants of CRP levels in this population. Key Words: C-reactive protein Ⅲ carotid plaques Ⅲ inflammation Ⅲ body mass index Ⅲ intima-media thickness.I nflammation is a key feature of the development of atherosclerotic plaque. 1 Serum levels of C-reactive protein (CRP), a major acute-phase protein, represent a clinical marker of inflammation. 2 Recent data have revealed that CRP is associated positively with acute myocardial infarction and sudden cardiac death in patients displaying stable or unstable angina. [3][4][5][6][7] Moreover, baseline levels of CRP in healthy subjects have been shown to predict future risk of the development of symptomatic peripheral vascular disease, 8 coronary heart disease, 9 -12 or both. 13,14 An association between CRP and the presence and number of stenosed coronary vessels has been documented in coronary atherosclerosis. [15][16][17][18][19][20] With respect to carotid atherosclerosis, 2 studies have shown a positive association between serum CRP levels and the presence of carotid plaques. 20,21 In the Bruneck Study (Willeit et al 21 ), a significant relationship between CRP and early nonstenotic atherosclerosis (Յ40% narrowing of the lumen) was restricted to univariate analysis. By contrast, in advanced stenotic atherosclerosis (Ͼ40% narrowing of the lumen), no association was found. These findings suggest that the relation of risk factors to atherosclerosis may vary according to the severity of the disease. Recently, an association between CRP and common carotid artery (CCA)-intima-media thickness (IMT) has been des...

Metabolic Syndrome and Early Carotid Atherosclerosis in the Elderly

“…In contrast, our study showed that the CRP level is not associated with the development of carotid plaque or progression of the C-IMT. This finding may be attributed to the relatively low levels of CRP observed in this study compared to other studies 34,35) , likely reflecting a minimal contribution to plaque formation. However, risk factors for the progression of C-IMT are inconsistent and differ according to sex, depending on the study participants 36,37) .…”

“…An increased level of CRP also reflects low-grade inflammation and is associated with carotid atherosclerosis, although there is a gender difference 34,35) . In contrast, our study showed that the CRP level is not associated with the development of carotid plaque or progression of the C-IMT.…”

Inflammation and Carotid Artery—Risk for Atherosclerosis Study (ICARAS)

“…Furthermore, the present results are in line with numerous former crosssectional studies. [37][38][39][40] Despite major advances in treatment of stroke, early identification and prevention of incident events remain crucial, because more than two thirds of all strokes occur without prior symptoms. Recently, Bertges et al 2 demonstrated that progression of carotid artery disease as indicated by duplex ultrasound investigations translates clinically into a substantially increased risk for ipsilateral neurological events.…”

New Risk Factors for Atherosclerosis and Patient Risk Assessment

“…31 High plasma levels of hs-CRP may be associated with a higher incidence of late adverse events after successful coronary stenting. 32 Elevated hs-CRP constitutes an independent predictor of advanced carotid plaques in dyslipidemic subjects, 33 and early-onset carotid atherosclerosis is associated with increased intima-media thickness and elevated serum levels of inflammatory markers. 34 A graded association between hs-CRP and carotid atherosclerosis has been demonstrated in women but not in men.…”