Socioeconomic status, C-reactive protein, immune factors, and responses to acute mental stress

Owen, Natalie; Poulton, T P; Hay, Frank C.; Mohamed‐Ali, Vidya; Steptoe, Andrew

doi:10.1016/s0889-1591(03)00058-8

Cited by 158 publications

(106 citation statements)

References 50 publications

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“…25 CRP level, a measurement of inflammation, is a well-established and independent predictor of cardiovascular events. [26][27][28][29] Previous studies of healthy adults have associated high CRP levels with low social class in childhood, 30,31 low occupational grade, 3 low educational level, [32][33][34] and low income level. 34 Our findings demonstrate that the association between low SES and CRP that was observed in healthy adults is also present in patients who have CHD.…”

Section: Discussionmentioning

confidence: 99%

“…Other possible pathways by which SES may influence cardiovascular outcomes include the effects of chronic stress, 3 dysregulation of the parasympathetic nervous system, 35 greater insulin resistance, 36 and differences in dietary, lifestyle, and behavior patterns. 37 Limited education and lack of financial resources may also affect access to quality medical care 38 and decrease adherence to medication.…”

Section: Discussionmentioning

confidence: 99%

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Relation of Low Socioeconomic Status to C-Reactive Protein in Patients With Coronary Heart Disease (from the Heart and Soul Study)

Lubbock

Goh

Ali

et al. 2005

The American Journal of Cardiology

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Low socioeconomic status (SES) is associated with poor health outcomes in patients who have coronary heart disease (CHD). Inflammation is a potential mechanism by which low SES may lead to adverse cardiovascular outcomes, but it is not known whether low SES is associated with inflammation in patients who have CHD. We measured high-sensitivity C-reactive protein (CRP) levels in a cross-sectional study of 985 adults who had CHD. Income and education were determined by self-report. We used ordinal logistic regression to examine the association of income and education with CRP. Of the 985 participants, 390 had high CRP levels (>3 mg/dl). The proportion of participants who had high CRP levels ranged from 30% (103 of 340) in those who had a college degree to 51% (65 of 127) in those who had less than a high school degree (p <0.0001). The proportion of subjects who had a high CRP level ranged from 28% (52 of 183) in those who had annual income >$50,000 to 42% (199 of 974) in those who had an annual income <$20,000 (p <0.001). After adjustment for traditional cardiovascular risk factors and other potential confounding variables, lower income and education remained associated with higher CRP levels. In conclusion, low SES is associated with high CRP levels in patients who have CHD. This observation raises the possibility that inflammation may contribute to the adverse cardiovascular outcomes associated with low SES.To determine the relation between socioeconomic status (SES) and level of C-reactive protein (CRP), we assessed income and education and measured CRP in a cross-sectional study of 985 adults who had coronary heart disease (CHD). We hypothesized that lower income and education would be associated with higher CRP levels after adjusting for demographic characteristics, traditional CHD risk factors, medical co-morbidities, medication use, and other clinical indicators. Methods ParticipantsThe Heart and Soul Study is a prospective cohort study that examines the influence of psychosocial factors on health outcomes in patients who have coronary artery disease. Methods have been described previously. A total of 15,438 eligible patients was mailed an invitation to participate, and 2,495 responded that they would be interested. Of the 2,495 patients whom we attempted to contact by telephone to schedule a study appointment, 505 could not be reached and 596 declined to participate. An additional 370 patients were excluded because they had a history of myocardial infarction in the previous 6 months, deemed themselves unable to walk 1 block, or were planning to move out of the local area within 3 years.Between September 2000 and December 2002, 1,024 participants enrolled and attended a daylong appointment at the Veterans Affairs Medical Center in San Francisco. For this crosssectional study, we excluded 39 subjects from whom we could not obtain serum samples, leaving 985 participants for analysis. This study protocol was approved by the appropriate institutional review boards, and all participants provided written, ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Relation of Low Socioeconomic Status to C-Reactive Protein in Patients With Coronary Heart Disease (from the Heart and Soul Study)

Lubbock

Goh

Ali

et al. 2005

The American Journal of Cardiology

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“…The clinical picture often is ambiguous [9], and although biomarkers like C-reactive protein (CRP) or leukocyte levels [4, 7, 9-11, 28, 34] are helpful, they can be misleading in patients with chronic inflammatory diseases, obesity, metabolic syndrome, and insulin resistance, and in smokers [3,4,27] and patients with postoperative hematomas [11,22].…”

Section: Introductionmentioning

confidence: 99%

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

Glehr

Friesenbichler

Hofmann

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background A periprosthetic joint infection is one of the most challenging complications associated with THA and TKA. In the diagnostic process for detecting a periprosthetic joint infection, one of the most important steps is analysis of laboratory infection biomarkers. Questions/purposes We investigated the sensitivity and specificity of the biomarkers procalcitonin, interleukin 6 (IL-6), and interferon a (IFN-a) as compared with conventional biomarkers (C-reactive protein [CRP], leukocyte level) for a periprosthetic joint infection associated with revision arthroplasties. Methods We prospectively included and analyzed 84 patients (124 revision arthroplasties). The blood parameters of interest were procalcitonin, IL-6, IFN-a, leukocyte level, and CRP. Samples were taken preoperatively and on the first, third, and seventh postoperative days. The sensitivity and specificity of these biomarkers then were calculated. Results Considering the preoperative values of 84 patients (124 operations), procalcitonin, IL-6, CRP, and leukocyte level correlated with periprosthetic joint infection, whereas IFN-a did not. A procalcitonin cut-off level of 0.35 ng/mL revealed a sensitivity of 80% and specificity of 37%. An IL-6 cut-off level of 2.55 pg/mL had a sensitivity of 92% and specificity of 59%. Conclusions In this study procalcitonin and IL-6 were helpful for detecting periprosthetic joint infections in revision arthroplasties, although CRP generally was superior. Procalcitonin and IL-6 may be considered adjuvant tests when the diagnosis of a periprosthetic joint infection is in doubt. This study showed, in addition to conventional biomarkers such as CRP and leukocyte level, procalcitonin and IL-6 were helpful for detecting infections associated with revision arthroplasties.

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“…ple, Owen et al 16 evaluated the relationship between C-reactive protein (CRP), immune factors, and SES among healthy volunteers from the Whitehall II study and found that higher CRP levels were associated with lower SES. Jousilahti et al 17 found a similar relationship between SES, CRP, serum amyloid A, and fibrinogen levels; mean levels of the aforementioned inflammatory markers decreased significantly with increasing SES.…”

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confidence: 99%

Impact of Traditional and Novel Risk Factors on the Relationship Between Socioeconomic Status and Incident Cardiovascular Events

et al. 2006

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Background-Persons of lower socioeconomic status have greater cardiovascular risk than those of higher socioeconomic status. However, the mechanism through which socioeconomic status affects cardiovascular disease (CVD) is uncertain. Virtually no data are available that examine the prospective association between novel inflammatory and hemostatic CVD risk indicators, socioeconomic status, and incident CVD events. Methods and Results-We assessed the relationship between 2 indicators of socioeconomic status (education and income), traditional and novel CVD risk factors (high sensitivity C-reactive protein, soluble intercellular adhesion molecule-1, fibrinogen, and homocysteine), and incident CVD events among 22 688 apparently healthy female health professionals participating in the Women's Health Study. These women were followed up for 10 years for the development of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death. More educated women were less likely to be smokers; had a lower prevalence of hypertension, diabetes, and obesity; and were more likely to participate in vigorous physical activity than less educated women. At baseline, median total cholesterol, low-density lipoprotein, triglyceride, C-reactive protein, intercellular adhesion molecule-1, fibrinogen, and homocysteine levels for women in 5 categories of education (Ͻ2 years of nursing education, 2 to Ͻ4 years of nursing education, a bachelor's degree, a master's degree, and a doctoral degree) and 6 categories of income [Յ$19 999, $20 000 to $29 999, $30 000 to $39 999, $40 000 to $49 999, $50 000 to $99 999, and Ն$100 000) decreased progressively with increasing education or income levels (all PϽ0.001), whereas an opposite pattern was observed for high-density lipoprotein (PϽ0.001).Overall, in age-adjusted Cox proportional hazards models, the relative risk of incident CVD events decreased with increasing education (1.0, 0.7, 0.5, 0.4, and 0.5; P for trend Ͻ0.001) and income (1.0, 1.0, 0.9, 0.7, 0.6, and 0.4; P for trend Ͻ0.001) categories. In multivariate models that assessed the impact of traditional and novel CVD risk factors on the relationship between education/income and CVD events, the relative hazard of incident CVD associated with a 1-category-higher level of education changed from 0.79 in age-and race-adjusted analysis to 0.89 in fully adjusted analysis. The 11% lower risk per 1 category of education remained significant (P for trendϭ0.006), suggesting that controlling for both novel and traditional risk factors could not explain the protective effect of education. A similar analysis for income revealed that its relationship with CVD events was explained largely by these noted risk factors. Conclusions-In this prospective analysis, we observed a decrease in incident CVD events with increasing levels of education and income. In contrast to the relationship between income and CVD events, the relationship of CVD events with education was explained only partially by traditional and novel risk factors for CV...

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Socioeconomic status, C-reactive protein, immune factors, and responses to acute mental stress

Cited by 158 publications

References 50 publications

Relation of Low Socioeconomic Status to C-Reactive Protein in Patients With Coronary Heart Disease (from the Heart and Soul Study)

Relation of Low Socioeconomic Status to C-Reactive Protein in Patients With Coronary Heart Disease (from the Heart and Soul Study)

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

Impact of Traditional and Novel Risk Factors on the Relationship Between Socioeconomic Status and Incident Cardiovascular Events

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