Modified low-density lipoprotein may moderate the association of baseline hs-CRP with incident cardiac events in the Asian populations

Abstract

Modified low-density lipoprotein may moderate the association of baseline hs-CRP with incident cardiac events in the Asian populations To the Editor, Baseline high-sensitivity C-reactive protein (hs-CRP) concentrations have been associated with incident cardiovascular disease in the general population, mainly in Western countries; however the association was controversial in the Asian populations [1,2]. Notably, the association was consistently present in the Asian patients with established cardiovascular disease [3,4]. Ogita et al. [5] further found that chronic kidney disease (CKD) may be a moderator for the association between baseline hs-CRP concentrations and the major adverse cardiovascular events in Japanese patients with stable coronary artery disease and who were implanted with first-generation drug-eluting stents. Similarly, Sung et al. [6] also revealed that baseline high-density lipoprotein cholesterol (HDL-C) concentrations may be a moderator for the association between hs-CRP concentrations and coronary artery calcium score in the Korean general population. Whether CRP is a causal or bystander of cardiovascular disease has been an ongoing debate since 2000. CRP could increase lectinlike oxidized low-density-lipoprotein (LDL) receptor 1 (LOX-1) release from macrophages to uptake LDL-cholesterol (LDL-C), and opsonize LDL-C to become capable of uptake by macrophages in the arterial wall [7]. Additionally, CRP may activate complement along with LOX-1 or by binding to modified LDL [8,9]. Evidence appears to indicate that CRP may contribute to the development of arteriosclerosis in the presence of modified LDL such as oxidized LDL [10]. Therefore, hs-CRP concentrations may be correlated with modified LDL concentrations, which were atherogenic and resulted in cardiovascular events, if HDL-C concentrations were low [11]. As we know, carbamylated LDL, occurring primarily in the presence of CKD, has been reported with an association with endothelial dysfunction. CRP incorporated with carbamylated LDL in CKD may lead to a higher risk of cardiovascular disease as well [12]. To date, the hs-CRP association with cardiovascular disease was not present in about one third of observational studies or clinical trials. In conclusion, modified LDL such as oxidized LDL and carbamylated LDL may be a potential moderator for the association of hs-CRP with cardiovascular disease in the Asian populations.

Clinical impact of high-sensitivity C-reactive protein during follow-up on long-term adverse clinical outcomes in patients with coronary artery disease treated with percutaneous coronary intervention

“…It has been indicated that CRP may contribute to the development of arteriosclerosis in the presence of modified low-density lipoprotein (LDL) such as oxidized LDL [19]. Lin et al explained that modified LDL may be a potential moderator for the association of hs-CRP with cardiovascular disease in Asian populations [20]. Previous reports have shown that anti-inflammatory therapy could improve clinical outcomes in CAD patients, with statins in particular shown to indirectly reduce hs-CRP along with LDL cholesterol (LDL-C), and to improve inflammation [21,22].…”

Serum Malondialdehyde-Modified Low-Density Lipoprotein as a Risk Marker for Peripheral Arterial Stiffness in Maintenance Hemodialysis Patients

“…The cumulative exposure to both traditional and non-traditional CVD risk factors in older HD patients may further contribute to the development of PAS [23]. Inflammation has been involved in the development of arterial stiffness and CVD events in CKD patients [42,47]. It has been well known that serum CRP may be a mediator of the development of CVD events and post-statin therapeutic CRP levels rather than LDL were associated with subsequent CVD events [48].…”