Modifiable lifestyle risk factors and C-reactive protein in patients with coronary artery disease: Implications for an anti-inflammatory treatment target population

Abstract

Background Modifiable lifestyle risk factors (modRF) of coronary artery disease (CAD) are associated with increased inflammation represented by elevated C-reactive protein (CRP) levels. Lifestyle changes may influence the inflammatory burden in patients with CAD, relevantly modifying the target population for emerging anti-inflammatory compounds. Aims The aims of this study were to analyse the association of modRF and CRP levels in CAD patients, and to define a potential target population for anti-inflammatory treatment with and without the optimisation of modRF. Methods We included all patients with angiographically documented CAD from the observational cohort study INTERCATH. Patients with recent myocardial infarction, malignancy, infectious disease, and pre-existing immunosuppressive medication including a history of solid organ transplantation were excluded. Overweight (body mass index (BMI) ≥ 25 kg/m2), smoking, lack of physical activity (PA; <1.5 h/week), and poor diet (≤12 points of an established Mediterranean diet score (MDS), range 0–28 points) were considered as modRF. CRP was measured by a high-sensitivity assay (hsCRP) at baseline. We performed multivariable linear regressions with log-transformed hsCRP as the dependent variable. Based on these associations, we calculated potential hsCRP levels for each patient, assuming optimisation of the individual modRF. Results Of 1014 patients, 737 (73%) were male, the mean age was 69 years, and 483 (48%) had an hsCRP ≥ 2 mg/l. ModRF were significantly overrepresented in patients with hsCRP ≥ 2 mg/l compared to patients with an hsCRP < 2 mg/l (BMI ≥ 25 kg/m2: 76% vs 61%; PA < 1.5 h/week: 69% vs 57%; MDS ≤ 12: 46% vs 37%; smoking: 61% vs 54%; p < 0.05 for all). hsCRP increased with the incremental number of modRF present (median hsCRP values for N = 0, 1, 2, 3, and 4 modRF: 1.1, 1.0, 1.6, 2.4, 2.8 mg/l, p < 0.001). Multivariable linear regression adjusting for age, sex, intake of lipid-lowering medication, and diabetes mellitus revealed independent associations between log-transformed hsCRP and all modRF (BMI ≥ 25 kg/m2: exp(ß) = 1.55, p < 0.001; PA < 1.5 h/week: exp(ß) = 1.33, p < 0.001; MDS ≤ 12: exp(ß) = 1.18, p = 0.018; smoking: exp(ß) = 1.18, p = 0.019). Individual recalculation of hsCRP levels assuming optimisation of modRF identified 183 out of 483 (38%) patients with hsCRP ≥ 2 mg/l who could achieve an hsCRP < 2 mg/l via lifestyle changes. Conclusion modRF are strongly and independently associated with CRP levels in patients with CAD. A relevant portion of CAD patients with high inflammatory burden could achieve an hsCRP < 2 mg/l by lifestyle changes alone. This should be considered both in view of the cost and side-effects of pharmacological anti-inflammatory treatment and for the design of future clinical trials in this field.

South Indian Cuisine with Low Glycemic Index Ingredients Reduces Cardiovascular Risk Factors in Subjects with Type 2 Diabetes

“…A recent study showed that 39.2% of patients with type 2 diabetes had RIR and the findings suggested that glycemic control, insulin resistance, non-LDL-C lipid variables and central obesity are implicated in RIR in patients with type 2 diabetes even with well-controlled LDL-C levels [ 33 ]. These findings support the observations that patients with high inflammatory burden could achieve an hs-CRP <2 mg/L by lifestyle modifications alone [ 34 ].…”

Anti-inflammatory medications and coronary artery disease

“…alcohol, body mass index, diet, physical activity, smoking and waist-to-hip ratio). 7 Supporting the INTERCATH cohort results of Blaum et al, 1 studies of lifestyle modifications in the USA have also reported beneficial cardiovascular outcomes, suggesting that the effects are not unique to the former population. 4,23 These studies also infer, but did not directly prove, an association between high CRP levels and CAD.…”

“…In the research article 'Modifiable lifestyle risk factors and CRP in patients with coronary artery diseaseimplications for an anti-inflammatory treatment target population', Blaum et al 1 addressed the relevant and important association between inflammation and serum levels of C-reactive protein (CRP) in a hospital-based cohort study of patients with coronary artery disease (CAD) in Germany. Their results present a promising approach in the management of CAD.…”

“…Even after adjusting for various outcome-related covariates, CRP levels are known to be higher among women. 24 However, Blaum et al 1 did not separately report CRP levels by gender and its association with CAD. Furthermore, no details were provided about the ethnicity and race of the study population, important risk factors for CAD.…”

The Beneficial Role of Exercise Training for Myocardial Infarction Treatment in Elderly

“…Aging is independently associated with peak oxygen uptake (VO 2 peak) and total work capacity (TWC), accounting for nearly 70% of the age-related decay (Marchionni et al, 2000). Controlling life risk factors including physical inactivity and sedentary behaviors might be an effective method to reduce global mortality and morbidity in patients with CVD (Fletcher et al, 2018;Blaum et al, 2019;Lavie et al, 2019). Lifelong (>25 years) exercise may alleviate a sedentary-and aging-induced decrease in systolic longitudinal strain (LS) through improving left ventricular (LV) diastolic filling (Howden et al, 2018).…”