Elevated C-reactive protein: a common marker for atherosclerotic cardiovascular risk and subclinical stages of pulmonary dysfunction and osteopenia in a healthy population

Possible Gender Difference in the Association Between Abdominal Obesity, Chronic Inflammation, and Preclinical Atherosclerosis in the General Population

Chronic inflammation due to abdominal obesity plays a major role in the development of cardiovascular disease (CVD). Gender differences are well characterized in the development of CVD; however, in the association among abdominal obesity, chronic inflammation, and preclinical atherosclerosis, gender differences in the general population remain to be clarified. We retrospectively analyzed 1,163 subjects who underwent voluntary health checkups at our institute. We defined carotid artery plaque formation as carotid intima-media thickness ≥ 1.1 mm. Multiple regression analysis showed that waist circumference was a major independent predictor of increase in serum C-reactive protein (CRP) level in both men and women. Serum CRP level was significantly increased in men with carotid artery plaque formation, but not in women. Multivariable logistic regression analysis demonstrated that serum CRP level, as well as age and hypertension, was independently associated with carotid artery plaque formation only in men. This result may suggest a potential of gender-specific difference in the association between serum CRP level and the prevalence of carotid artery plaque formation. Further investigations are required to confirm our results and to clarify the underlying mechanism.

Calcification of lower extremity arteries is related to the presence of osteoporosis in postmenopausal women with type 2 diabetes mellitus: a cross-sectional observational study

It is unknown whether there is any relationship between extremity arterial macroangiopathy and osteoporosis in type 2 diabetic mellitus (T2DM) patients. We provide evidence to show the association between lower extremity arterial calcification and the presence of osteoporosis in postmenopausal T2DM women, but not in T2DM men of similar age.

PURPOSE

To investigate the relationship between lower extremity arterial calcification and the presence of osteoporosis in type 2 diabetic mellitus (T2DM) patients.

METHODS

We performed a retrospective cross-sectional study in patients with T2DM. They were assigned into two groups (patients with or without vascular calcification) in both sexes. Clinical characteristics, presence of osteoporosis, and bone metabolic markers were compared. Arterial calcification was determined by ultrasonography examination. Osteoporosis was defined based on the measurements from dual-energy X-ray absorptiometry. The relationship between the lower extremity arterial calcification and the presence of osteoporosis was analyzed. Statistical analysis was performed in SPSS 26.0.

RESULTS

A total of 933 T2DM patients (535 men ≥ 50 years old, and 398 postmenopausal women) were identified and analyzed. A significant association between arterial calcification and osteoporosis was only observed in women, with a higher prevalence of osteoporosis observed in women with calcification (40.8%) than in women without calcification (26.9%) (P = 0.004). Compared to women without calcification, women with calcification had lower bone mineral densities in the hip (P < 0.001) and femoral neck (P < 0.001). Ordinal logistic regression analysis showed that women with calcification had a nearly 2-fold increased risk for osteoporosis, even after adjusting for age, duration of T2DM, body mass index, pulse pressure, clearance of creatinine, glycosylated hemoglobin, and fasting C-peptide. Similar differences were not identified between men with and without calcification.

CONCLUSION

Calcification of lower extremity arteries is related with the presence of osteoporosis in postmenopausal T2DM women.

The relationship between atherosclerosis and bone mineral density in patients with type 2 diabetes depends on vascular calcifications and sex

It is unknown whether a relationship exists between bone mineral density (BMD) and atherosclerosis with or without vascular calcification. In our study, a negative correlation between carotid atherosclerosis and BMD was found in female T2DM patients with vascular calcification, but not in those without calcification and males.

INTRODUCTION

Atherosclerosis is considered associated with low bone mineral density (BMD). However, most previous studies focus on patients with arterial atherosclerosis with vascular calcification. It is still unknown whether a relationship exists between atherosclerosis and BMD in patients without calcification. It is also unknown if sex plays a role in this relationship.

METHODS

We performed a retrospective cross-sectional study, which included 1459 type 2 diabetes mellitus (T2DM) patients (648 males ≥ 50 years old, and 811 postmenopausal females). They were assigned to three groups: group 1 (patients without carotid plaques and without carotid calcification), group 2 (patients with carotid plaques but without carotid calcification), and group 3 (patients with carotid plaques and with carotid calcification). Clinical characteristics and BMD were compared. The relationship between atherosclerosis and BMD was determined by binary logistic regression analysis. Statistical analysis was performed using SPSS 25.0.

RESULTS

Significant differences were only observed in women. The percentage of osteoporosis was higher in group 3 (43.64%) than in groups 1 (34.82%) and 2 (32.14%) (P = 0.016). Low BMD was found in the lumbar (P = 0.032), hip (P < 0.001), and femoral neck (P < 0.001). The odds ratio for osteoporosis increased significantly in a score-dependent manner in postmenopausal female patients with calcified atherosclerosis, but not in uncalcified patients. In men, no differences or relationships were identified.

CONCLUSION

A negative correlation between carotid atherosclerosis and BMD was found in female T2DM patients with vascular calcification, but not in those without calcification. A similar relationship was not observed in male patients with or without calcification. Thus, the relationship between atherosclerosis and bone mineral density in patients with type 2 diabetes depends on vascular calcifications and sex.

C-reactive protein gene rs1205 polymorphism is associated with low-grade chronic inflammation in postmenopausal women

Background

Cardiovascular disease is the leading cause of death in postmenopausal women, and inflammation is a key mechanism involved in the pathogenesis of atherosclerosis. High-sensitivity C-reactive protein (hs-CRP) has been used as a biomarker of inflammation. Considering that CRP gene rs1205 polymorphism has been associated with hs-CRP circulating levels, we evaluated whether rs1205 genotypes influence the presence of low-grade chronic inflammation, acting as a marker of cardiovascular risk.

Methods

We performed a cross-sectional study with biobanked blood samples from 327 postmenopausal women with no evidence of clinical disease. Genotyping for rs1205 C > T SNP of the CRP gene was done by real-time polymerase chain reaction with allelic discrimination assays.

Results

Mean age was 55.6 ± 5.6 years. Mean body mass index (BMI) was 27.3 ± 4.7. Participants were divided according to hs-CRP levels: ≥3 mg/l (low-grade chronic inflammation) or < 3 mg/l. The frequency of allele C at rs1205 was 74.2% in the hs-CRP ≥ 3 mg/l group vs. 59% in the hs-CRP < 3 mg/l. In a multivariable model, higher prevalence of hs-CRP ≥ 3 mg/l was associated with CC genotype (PR 1.53; 95%CI 1.07-2.18; p = 0.018) and waist circumference ≥ 88 cm (PR 2.45; 95%CI 1.66-3.60; p < 0.001).

Conclusions

CRP rs1205 CC homozygotes may be at higher risk of a low-grade chronic inflammatory status compared to individuals carrying the T allele.

Independent association of bone mineral density and trabecular bone score to vertebral fracture in male subjects with chronic obstructive pulmonary disease

Osteoporosis is a major comorbidity of chronic obstructive pulmonary disease (COPD), but the mechanism of bone fragility is unknown. We demonstrated that trabecular bone score, a parameter of bone quality, was associated with systemic inflammation and was a significant determinant of vertebral fracture independent of bone mineral density.

INTRODUCTION

COPD is a major cause of secondary osteoporosis. However, the mechanism of bone fragility is unclear. We previously reported that vertebral fracture was highly prevalent in male COPD patients. To obtain clues to the mechanism of COPD-associated osteoporosis, we attempted to identify determinants of prevalent vertebral fracture in this study.

METHODS

In this cross-sectional study, we recruited 61 COPD males and examined pulmonary function, vertebral fractures, bone mineral density (BMD), trabecular bone score (TBS), bone turnover markers, and inflammatory parameters. Determinants of the bone parameters were examined by multivariable analyses.

RESULTS

The prevalence of any and grade 2 or 3 fractures was 75.4 and 19.7%, respectively. Osteoporosis and osteopenia defined by BMD were present in 37.7 and 39.3%, respectively. TBS was significantly lower in higher Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages compared to GOLD 1. Multivariable logistic regression analysis revealed that both TBS and BMD were independent determinants of grade 2 or 3 vertebral fractures (OR = 0.271, 95%CI 0.083-0.888, p = 0.031; OR = 0.242, 95%CI 0.075-0.775, p = 0.017) after adjustment for age. Correlates of TBS included age, BMD, high-sensitivity C-reactive protein (hsCRP), pulmonary function parameters, parathyroid hormone, and Tracp-5b. In multivariable regression analysis, hsCRP was the only independent determinant of TBS besides age and BMD. In contrast, independent determinants of BMD included body mass index and, to a lesser extent, 25-hydroxyvitamin D.

CONCLUSION

Both BMD and TBS were independently associated with grade 2 or 3 vertebral fracture in COPD male subjects, involving distinct mechanisms. Systemic inflammation, as reflected by increased hsCRP levels, may be involved in deterioration of the trabecular microarchitecture in COPD-associated osteoporosis, whereas BMD decline is most strongly associated with weight loss.

Association of type 2 diabetes and an inflammatory marker with incident bone fracture among a Japanese cohort

AIMS/INTRODUCTION

There are various causes of incident bone fracture. Not only aging, low bone mineral density and history of previous fracture, but also diabetes mellitus and inflammation are regarded as risk factors for fracture. The purpose of the present study was to verify the association of glycemic control or one inflammatory marker with incident fracture in a large-scale Japanese cohort.

MATERIALS AND METHODS

The present study was carried out at the Hiroshima Atomic Bomb Casualty Council and included 6,556 participants (2,785 men and 3,771 women, aged 55-87 years) who underwent annual health examinations and were followed for 7.4 years. Information about incident fractures was collected at interviews. Participants were classified into three groups: normal, borderline and diabetes mellitus according to glycohemoglobin levels (treated diabetes patients were included in the diabetes mellitus group). Furthermore, participants were classified into four additional groups by glycemic control (diabetes mellitus or non-diabetes mellitus) and C-reactive protein (CRP) levels (low or high). Hazard ratios (HRs) of diabetes mellitus, CRP and their combined risk of incident fracture were evaluated.

RESULTS

After adjusting for age, bone mineral density and previous fracture, CRP was associated with increased fracture risk (in men HR 1.04, 95% confidence interval [CI]: 1.003-1.06; in women HR 1.07, 95% CI: 1.03-1.13), and diabetes mellitus predicted fracture risk in men (HR 1.31, 95% CI: 1.02-1.51). Fracture risk was significantly higher among the diabetes mellitus with high CRP group compared with the non-diabetes mellitus with low CRP group (in men HR 1.47, 95% CI: 1.02-1.98; in women HR 1.41, 95% CI: 1.04-1.92).

CONCLUSIONS

Among a Japanese cohort, CRP measurements were helpful to detect high fracture risk in patients with type 2 diabetes mellitus.

Comparative study of the correlation between atherosclerosis and osteoporosis in women in Japan and Mongolia

Objective

Associations between vascular calcification and osteoporosis are well documented, yet effects of lifestyle on atherosclerosis and osteoporosis remain unclear. This study evaluated the relationship between atherosclerosis and osteoporosis of people with different lifestyles living on Uku Island in Japan (rice consumption and fishing lifestyle) and in Ulaanbaatar in Mongolia (meat consumption and nomadic lifestyle), and investigated the differences of lifestyles on atherosclerosis and osteoporosis.

Methods

Participants were women aged over 50 years who had undergone a previous medical examination for atherosclerosis and osteoporosis (Uku Island, 104, Ulaanbaatar, 71). Lifestyle habits were obtained by questionnaire. Bone mineral density of the right calcaneus was measured using quantitative ultrasound. Brachial‐ankle pulse wave velocity was measured as an index of atherosclerosis.

Results

There were no significant differences in bone mineral density and brachial‐ankle pulse wave velocity between the two groups, even though meat and dairy intake, number of meals skipped, and number of children were significantly greater in participants from Ulaanbaatar compared with Uku Island. Brachial‐ankle pulse wave velocity showed significant positive correlations with age, systolic and diastolic blood pressures, and body mass index and a significant negative correlation with bone mineral density for both groups. With step‐wise multiple regression analysis, brachial‐ankle pulse wave velocity significantly correlated with age and bone mineral density for both populations. Systolic blood pressure significantly correlated with brachial‐ankle pulse wave velocity for the Ulaanbaatar group.

Conclusions

Despite significant lifestyle differences, similar relationships between atherosclerosis and osteoporosis were observed in women from Uku Island and Ulaanbaatar. Hypertension was a significant contributing factor for atherosclerosis for the Ulaanbaatar group.

Osteoporosis Associated with Chronic Obstructive Pulmonary Disease

Recent epidemiological studies have revealed that osteoporosis is closely associated with common chronic diseases including diabetes, hypertension, chronic kidney disorders, and chronic obstructive pulmonary disease (COPD). COPD is a chronic inflammatory airway disease but now well known to be associated with various systemic comorbidities including osteoporosis. Osteoporosis and osteoporotic fractures are extremely common in COPD patients, which have significant impacts on their quality of life (QOL), activities of daily life (ADL), respiratory function, and possibly their prognosis. COPD-associated osteoporosis is however extremely under-recognized, hence undertreated. Recent studies have suggested that both decreased bone mineral density (BMD) and impaired bone quality compromise bone strength causing fractures in COPD. In COPD patients, various general clinical risk factors for osteoporosis are present including smoking, older age, low body weight, and physical inactivity. In addition, disease-related risk factors such as decreased pulmonary function, inflammation, glucocorticoid use and vitamin D deficiency/insufficiency have been linked to the development of osteoporosis in COPD. Increased awareness of osteoporosis in COPD, especially that of high prevalence of vertebral fractures is called upon among general physicians as well as pulmonologists. Routine screening for osteoporosis and risk assessment of fractures will enable physicians to diagnose COPD patients with comorbid osteoporosis at an early stage. Timely prevention of developing osteoporosis together with appropriate treatment of established osteoporosis may improve QOL and ADL of the COPD patients, preserve their lung function and eventually result in better prognosis in these patients.

Low grade inflammation is associated with lower velocity of sound and broadband ultrasound attenuation in older men, but not with bone loss or fracture risk in a longitudinal aging study

OBJECTIVES

Elevated systemic levels of pro-inflammatory cytokines involved in the pathogenesis of osteoporosis. Our objective was to investigate whether low grade systemic inflammation was associated with bone markers, bone quality, bone mass and fracture risk in a population of older persons.

METHODS

Serum interleukin 6 (IL-6), high-sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR) were measured in 1287 participants of the Longitudinal Aging Study Amsterdam (LASA), a population based study in a representative sample of older men and women (age 76 ± 6.7 years). Bone quality was measured by quantitative ultrasound measurements (QUS) at baseline and after 3 years at the calcaneus, and bone mineral density was measured by dual-energy X-ray absorptiometry (DXA) at the spine and hip in a subpopulation. Furthermore, the bone markers osteocalcin (OC) and urinary excretion of deoxypyridinoline (DPD) were determined. Incident clinical fractures were recorded during 6 years of follow-up.

RESULTS

Multivariable regression analyses revealed higher IL-6 and ESR levels were associated with lower quantitative ultrasound values in older men (β=-0.98; 95% CI -57.72 to -6.42, p<0.05) and (β=-0.221; 95% CI -15.39 to -3.27, p<0.05) respectively at baseline, but not in women. No significant associations were found between inflammatory markers and bone markers, bone loss at the spine or hips, fracture rate or time to fracture.

CONCLUSION

Elevated inflammatory markers are associated with impaired bone quality in older men, but not in women. No associations were found with the risk for fractures.

Osteoporosis is highly prevalent in Japanese males with chronic obstructive pulmonary disease and is associated with deteriorated pulmonary function

Osteoporosis has recently been recognized as a major comorbidity in chronic obstructive pulmonary disease (COPD). We conducted a cross-sectional study in a cohort of 136 Japanese males with COPD to evaluate the prevalence of vertebral fracture (VF) and to explore its relationship with pulmonary function parameters. VFs were present in 108 (79.4%); multiple and severe (SQ grade 2 or 3) VFs were found in 77 (56.6%) and 25 (18.4%), respectively. Multivariate logistic regression analyses revealed that decrease in forced expiratory volume in one second (FEV1.0)/forced vital capacity (FVC) [odds ratio (OR) 0.963, 95% confidence interval (CI) 0.929-998, p = 0.036] was associated with the presence of VF after adjustment for age and that FVC (OR 0.462, 95% CI 0.220-0.968, p = 0.041) and current smoking (OR 2.992, 95% CI 1.128-7.940, p = 0.028) were associated with VF severity (grade 2-3 vs. 1). We also found that FEV1.0 was the sole independent determinant of the number of VFs by stepwise multivariate linear regression (p < 0.001). Bone mineral density (BMD) values were available in 49 subjects. Mean T scores were -2.0 ± 1.2 in femoral neck, -1.4 ± 1.2 in total hip and -1.1 ± 1.4 in lumbar spine. Nineteen patients (38.8%) had a BMD T score less than -2.5. BMD Z scores of all the sites showed a progressive decrease as GOLD stage of COPD advanced (p < 0.05). Our results indicate a high prevalence of osteoporosis in Japanese male COPD patients and a strong inter-relationship between the two diseases, re-emphasizing the urgent need for appropriate intervention to maintain both bone and lung health.

Surface plasmon resonance-based immunoassay for human C-reactive protein

A rapid and highly-sensitive surface plasmon resonance (SPR)-based immunoassay (IA) has been developed and validated for detecting human C-reactive protein (CRP), a specific biomarker for inflammatory and metabolic disorders, and infections.

Analysis of Gene and Protein Expression in Atherosclerotic Mouse Aorta by Western Blot and Quantitative Real-Time PCR

Atherosclerosis involves changes in gene and protein expression patterns in affected arteries. Quantification of these alterations is essential for understanding the molecular mechanisms underlying this pathology. Western blot and real-time PCR-used to quantify protein and messenger RNA levels, respectively-are invaluable molecular biology tools, particularly when material is limited. The availability of many genetically modified mouse models of atherosclerosis makes the mouse aorta an ideal tissue in which to carry out these expression pattern analyses. In this chapter, protocols are presented for mRNA and protein extraction from mouse aorta and for the accurate quantification of mRNA expression by RT-PCR and of proteins by western blot.

Airflow limitation in smokers is associated with arterial stiffness: the Nagahama Study

BACKGROUND

Pathophysiological mechanisms of associations between airflow limitation (AL) and arterial stiffness remain unclear. One factor that might affect both AL and arterial stiffness is habitual smoking. The aim of this study is to investigate a possible interaction of smoking on the association between AL and arterial stiffness.

METHODS

Study subjects consisted of 8790 apparently healthy community residents. Airflow limitation was defined as a ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity of less than 70%. Brachial-to-ankle pulse wave velocity (baPWV) was used as an index of arterial stiffness. Smoking habit was investigated using a structured questionnaire.

RESULTS

Subjects with AL had significantly higher baPWV (AL 1381 ± 334, control 1261 ± 227 cm/s, p < 0.001). In a separate analysis by smoking habit, advanced arterial stiffness in AL was observed only in smokers (non-smokers: AL 1300 ± 220, control 1260 ± 218; smokers: AL 1436 ± 384, control 1264 ± 243 cm/s). Other clinical features of subjects with AL were older age; increased plasma hsCRP levels; and a high prevalence of male sex, hypertension, and smoking experience. Multiple linear regression analysis adjusted for these covariates identified the smoking × AL interaction as an independent determinant of baPWV (β = 0.066, p < 0.001). Conversely, baPWV was an independent determinant of AL in current and past smokers, but not in never smokers.

CONCLUSIONS

AL arising from cigarette smoking, but not AL in non-smokers, was associated with arterial stiffness in a general population independently of established risk factors. Measurement of subclinical arterial change in smokers may be useful in identifying persons at risk for AL.

Age-associated chronic diseases require age-old medicine: role of chronic inflammation

Most chronic diseases--such as cancer, cardiovascular disease (CVD), Alzheimer disease, Parkinson disease, arthritis, diabetes and obesity--are becoming leading causes of disability and death all over the world. Some of the most common causes of these age-associated chronic diseases are lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption. All the risk factors linked to these chronic diseases have been shown to up-regulate inflammation. Therefore, downregulation of inflammation-associated risk factors could prevent or delay these age-associated diseases. Although modern science has developed several drugs for treating chronic diseases, most of these drugs are enormously expensive and are associated with serious side effects and morbidity. In this review, we present evidence on how chronic inflammation leads to age-associated chronic disease. Furthermore, we discuss diet and lifestyle as solutions for age-associated chronic disease.

Risk factors for fractures among Japanese-American men: The Honolulu Heart Program and Honolulu-Asia Aging Study

Baseline risk factors were associated with fractures that developed after 29-31 years among Japanese-American men. Hip fracture risk increased with increasing BMI (28% increase for 1 U increase), physical activity (7% increase for 1 U increase), and was decreased with increasing arm girth (27% decrease for 1 U increase).

PURPOSE

The objective of this study was to identify risk factors among Japanese-American men aged 45-68 years at baseline that were associated with prevalence and incidence of fractures at advanced age.

METHODS

We used baseline information from Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS). The HHP was a prospective study with primary focus on risk factors for cardiovascular disease. A cohort of 8,006 men of Japanese ancestry aged 45-68 years residing on Oahu was recruited in 1965 and followed for 31 years. The HAAS started in 1991 in conjunction with the HHP with a focus on age-related health conditions. Self-reported hip, spine, and forearm fracture prevalence was ascertained in 1991-1993 among 3,845 men aged 71-93 years. Incidence was obtained during the period (1994-1999) among 2,737 men aged 74-98 years. Poisson regression models were used to determine multi-variable adjusted prevalence and incidence ratios for fracture.

RESULTS

Incident hip fracture was directly associated with baseline body mass index (BMI) and physical activity, and inversely associated with left upper arm girth. Incident spine fracture was directly associated with baseline age. Prevalent hip fracture was directly associated with baseline pack-years of smoking. Prevalent spine fracture was inversely associated with baseline education, and directly associated with standing height and use of medication for diabetes. Prevalent forearm fracture was inversely associated with baseline age, and directly associated with education.

CONCLUSIONS

Results indicated that multiple baseline demographic lifestyle and anthropometric characteristics predict fracture risk at advanced age. In addition, associations varied by fracture location.

Systemic inflammation and reduced pulmonary function in chronic spinal cord injury

OBJECTIVE

To evaluate the relationship between systemic inflammation and pulmonary function in persons with chronic spinal cord injury (SCI).

DESIGN

Cross-sectional study.

SETTING

Veterans Affairs Medical Center.

PARTICIPANTS

Fifty-nine men with chronic SCI participating in a prior epidemiologic study.

METHODS

Standardized assessment of pulmonary function and measurement of plasma C-reactive protein (CRP) and interleukin-6 (IL-6).

MAIN OUTCOME MEASUREMENTS

Forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC).

RESULTS

Persons with the highest values of IL-6 had the lowest %-predicted FEV(1) and FVC. There was a significant inverse linear trend between quartile of IL-6 and %-predicted FEV(1) (P < .001) and FVC (P < .006), unadjusted and adjusted for SCI level and completeness of injury, obstructive lung disease history, smoking, and body mass index (P = .010-.039). Although not as strong as for IL-6, there also were similar trends for %-predicted FEV(1) and FVC with CRP.

CONCLUSIONS

In chronic SCI, higher levels of IL-6 and CRP were associated with a lower FEV(1) and FVC, independent of level and completeness of injury. These results suggest that the reduction of pulmonary function after SCI is related not only to neuromuscular impairment but also to factors that promote systemic inflammation.

Resting heart rate is associated with cardiovascular and all-cause mortality after adjusting for inflammatory markers: the Copenhagen City Heart Study

AIMS

To investigate the association between resting heart rate (RHR) and markers of chronic low-grade inflammation. Also, to examine whether elevated resting heart rate is independently associated with cardiovascular and all-cause mortality in the general population, or whether elevated RHR is merely a marker of chronic low-grade inflammation.

METHODS AND RESULTS

A group of 6518 healthy subjects from the the Danish general population were followed for 18 years during which 1924 deaths occurred. Subjects underwent assessment of baseline RHR, conventional cardiovascular risk factors, high-sensitivity C-reactive protein (hsCRP), and fibrinogen. RHR was associated with hsCRP and fibrinogen in uni- and multivariate models (p < 0.0001). A 10 beats per minute increase in RHR was associated with increased cardiovascular and all-cause mortality in univariate models - HR (95%CI) (1.21 (1.14-1.29) and 1.15 (1.11-1.19); multivariate models adjusted for conventional risk factors - 1.16 (1.09-1.24) and 1.10 (1.06-1.14); multivariate models including hsCRP - 1.14 (1.07-1.22) and 1.09 (1.05-1.14); fibrinogen - 1.15 (1.07-1.22) and 1.09 (1.05-1.14); and both hsCRP and fibrinogen - 1.14 (1.07-1.22) and 1.09 (1.05-1.14).

CONCLUSION

RHR was associated with markers of chronic low-grade inflammation. However, RHR remained associated with both cardiovascular and all-cause mortality after adjusting for markers of chronic low-grade inflammation. This suggests that RHR is an independent risk factor for cardiovascular and all-cause mortality, and not merely a marker of chronic low-grade inflammation.

Association of CRP and IL-6 with lung function in a middle-aged population initially free from self-reported respiratory problems: the Whitehall II study

To assess whether two inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6), and change in their concentrations over 12 years, are associated with lung function (FVC and FEV(1)) 12 years after baseline. Data are from over 1,500 participants free from self-reported respiratory problems in a large-scale prospective cohort study of white-collar male and female civil servants. CRP and IL-6 measured at baseline (1991-1993) and follow-up (2002-2004) and FVC and FEV(1), measured at follow-up. Results adjusted for sociodemographic and anthropometric characteristics, health behaviours, biological factors, chronic conditions and medications, and corrected for short-term variability in CRP and IL-6 concentrations. Higher baseline levels of CRP and IL-6 were strongly associated with lower FVC and FEV(1), independent of potential confounders. A 10% increase serum CRP from baseline to follow-up was associated with lower values of FVC and FEV(1) at follow-up, 4.7 and 3.0 ml, respectively. The corresponding values for a 10% increase in IL-6 were 12.6 ml for FVC and 7.3 ml for FEV(1). Systemic low-grade inflammation is associated with only slightly poorer pulmonary function in a population free from self-reported respiratory problems 12 years earlier. These data provide evidence linking inflammation to adverse outcomes beyond cardiovascular disease. Interventions targeting inflammation may prevent lung function impairment.

Contribution of serum inflammatory markers to changes in bone mineral content and density in postmenopausal women: a 1-year investigation

Bone formation and resorption are influenced by inflammatory processes. We examined the relationships among inflammatory markers and bone mineral content (BMC) and density (BMD) and determined the contribution of inflammatory markers to 1-yr changes in BMC and BMD in healthy postmenopausal women. This analysis included 242 women at baseline from our parent Soy Isoflavones for Reducing Bone Loss project who were randomly assigned to 1 of 3 treatment groups: placebo, 80 mg/d soy isoflavones, or 120 mg/d soy isoflavones. BMD and BMC from the lumbar spine (LS), total proximal femur (hip), and whole body were measured by dual energy X-ray absorptiometry and the 4% distal tibia by peripheral quantitative computed tomography. Serum inflammatory markers (C-reactive protein, interleukin [IL]-1 beta, IL-6, tumor necrosis factor-alpha [TNF-alpha], and white blood cell count [WBC]) were measured at baseline, 6, and 12 mo. Because of attrition or missing values, data analysis at 12 mo includes only 235 women. Significant associations among IL-6, TNF-alpha, and WBC were observed with percent change in LS, hip, and whole body BMC and BMD. Multiple regression analysis indicated that in combination inflammatory markers accounted for 1.1-6.1% of the variance to the observed 12-mo changes in BMC and BMD. Our results suggest that modifying inflammatory markers, even in healthy postmenopausal women, may possibly reduce bone loss.

Continuous smoking and progression of arterial stiffening: a prospective study

OBJECTIVES

We prospectively and longitudinally determined the effects of smoking on the progression of arterial stiffening as well as the involvement of inflammation in this process.

BACKGROUND

Smoking is an important avoidable risk factor for cardiovascular disease, and arterial stiffness might be involved in the pathophysiology. No prospective study has examined the effect of continuous smoking on the age-associated progression of arterial stiffening.

METHODS

In 2,054 Japanese subjects (40 +/- 8 years of age), brachial-ankle pulse wave velocity (baPWV) and serum C-reactive protein (CRP) levels were measured at the baseline and the end of a 5- to 6-year follow-up period.

RESULTS

The annual rate of change of the baPWV during the study period was significantly greater in the continuous heavy smokers (11.0 +/- 1.9 cm/s/year, n = 181) than in the never-smokers (5.5 +/- 0.6 cm/s/year, n = 1,018). This difference remained significant even after adjustments for covariates, including age (p < 0.05). In continuous smokers (n = 493), the mean number of cigarettes smoked/day during the study period showed a significant relationship with the changes in baPWV. No significant relationship was found between the change in baPWV and serum CRP levels.

CONCLUSIONS

Continuous smoking might accelerate the age-associated progression of structural stiffening of the large- to middle-size arteries. We also found a dose-response relationship between cigarette consumption and accelerated arterial stiffening. However, we failed to confirm any significant association between the rate of arterial stiffening and the serum CRP levels in the smokers.

Polymorphism of the C-reactive protein (CRP) gene is related to serum CRP Level and arterial pulse wave velocity in healthy elderly Japanese

The objective of this study was to clarify relationships between the C-reactive protein (CRP) gene and both the serum level of CRP and arterial pulse wave velocity (PWV), using haplotype analysis of healthy elderly Japanese. Five single-nucleotide polymorphisms (SNPs) of the human CRP gene (rs1341665, rs3091244, rs1800947, rs1130864 and rs1205) were used to genotype 315 healthy elderly Japanese subjects (mean age, 77.9 +/- 4.1 years; male/female ratio, 0.96). Linkage disequilibrium was analyzed for the five SNPs. The frequency of each haplotype and diplotype was estimated using the expectation/maximization (EM) algorithm. There were statistically significant associations between the CRP level and two CRP genotypes; the p value for the T allele of rs3091244 (CT + AT + TT vs. CC + CA + AA) was 0.002 (95% confidential interval [CI], 2.1-24), and the p value for the T allele of rs1130864 (TT + TC vs. CC) was 0.002 (95% CI, 2.1-24). The only genotype that was significantly associated with arterial PWV was the C allele of rs1800947, with a p value of 0.039. The haplotype was constructed using rs1341665, rs3091244 and rs1800947, in that order. There was a significant association between the CRP level and the T-T-G haplotype, with a p value of 0.002 (95% CI, 2.1-24). There was a significant association between arterial PWV and the C-C-C haplotype, with a p value of 0.039. We concluded that rs3091244, rs1130864 and the T-T-G haplotype are genetic markers for elevated basal CRP levels. rs1800947 and the C-C-C haplotype appear to be susceptibility markers for atherosclerosis, but this requires confirmation.

Relationships of C-reactive protein, uric acid, and glomerular filtration rate to arterial stiffness in Japanese subjects

The relationships between C-reactive protein (CRP), uric acid (UA), glomerular filtration rate (GFR), and arterial stiffness have not been fully investigated. The aim of this study was to clarify whether CRP, UA, and estimated GFR are related to arterial stiffness estimated using brachial-ankle pulse wave velocity (baPWV). The subjects were local government employees (3412 men and 854 women). baPWV, CRP, UA, GFR, and conventional risk factors were evaluated. Multiple linear regression analyses revealed that CRP and UA were significantly related to an elevation of PWV in male and female subjects, and that the estimated GFR was significantly related to an elevation of PWV in male subjects. Significant progressive increases in baPWV were observed across the quartiles of CRP in male subjects and for UA in male and female subjects. In female subjects, the relationship of quartile CRP to baPWV had marginal significance (P = 0.055). But, in male and female subjects, quartile of estimated GFR had no significant association with PWV. These results suggest that CRP and UA are associated with an increase of arterial stiffness in male and female subjects, and that estimated GFR is possibly related to arterial stiffness in male subjects.