Brief review and critical examination of the use of hs-CRP for cardiac risk assessment with the conclusion that it is premature to use this test

Effects of Amyloid Light-Chain Amyloidosis on Clinical Characteristics and Prognosis in Multiple Myeloma: A Single-Center Retrospective Study

BACKGROUND

Amyloid light-chain amyloidosis (AL amyloidosis) is commonly associated with multiple myeloma. However, the clinical characteristics and prognosis of symptomatic and smoldering multiple myeloma with AL amyloidosis are not particularly clear.

METHODS

Patients with symptomatic and smoldering multiple myeloma in the Peking University First Hospital registry from 2010 to 2018 were studied. The clinical and laboratory information was collected from first presentation to death or until the last available clinical follow-up. The patients' survival and outcomes were analyzed, and the relationship between the clinical parameters and survival was also assessed.

RESULTS

Compared with symptomatic multiple myeloma patients without AL amyloidosis, patients with AL amyloidosis had higher incidence of BNP≧700pg/mL (P<0.001), ALP>187.5IU/L (P=0.032) and ALB<25g/L (P<0.001). Similarly, compared with smoldering multiple myeloma patients without AL amyloidosis, patients with AL amyloidosis had higher incidence of BNP≧700pg/mL (P=0.030) and Alb<25g/L (P=0.024). The existence of AL amyloidosis, especially those with the heart involvement, was related to shorter long-term survival of symptomatic and smoldering multiple myeloma according to univariate analyses. Renal involvement and gastrointestinal tract involvement had an impact on the prognosis of smoldering multiple myeloma but not on the symptomatic multiple myeloma. Cox regression model for overall survival detected BNP≧700pg/mL in symptomatic multiple myeloma having independent poorer prognostic significance (HR=2.455, P=0.004). Interestingly, BNP at diagnosis was significantly correlated with cardiac amyloidosis (r=0.496, P<0.001). Cox regression model for overall survival detected the presence of AL amyloidosis in smoldering multiple myeloma having independent poorer prognostic significance (HR=8.741, P=0.002).

CONCLUSION

AL amyloidosis is an independent poor prognostic factor for not only symptomatic multiple myeloma but also smoldering multiple myeloma. It is mainly because of involvement of important organs, especially the heart. AL amyloidosis probably has a greater impact on the prognosis of smoldering multiple myeloma than on the symptomatic multiple myeloma.

Expressions of plasma cystatin C, D-dimer and hypersensitive C-reactive protein in patients with intracranial progressive hemorrhagic injury after craniocerebral injury, and their clinical significance

ABSTRACT Objective To investigate the expressions of plasma cystatin C (Cys-C), D-dimer (D-D) and hypersensitive C-reactive protein (hs-CRP) in patients with intracranial progressive hemorrhagic injury (IPHI) after craniocerebral injury, and their clinical significance. Methods Forty-two IPHI patients and 20 healthy participants (control) were enrolled. The severity and outcome of IPHI were determined according to the Glasgow Coma Scale and Glasgow Outcome Scale, and the plasma Cys-C, hs-CRP and D-D levels were measured. Results The plasma Cys-C, D-D and hs-CRP levels in the IPHI group were significantly higher than those in the control group (p < 0.01). There were significant differences of plasma Cys-C, D-D and hs-CRP levels among different IPHI patients according to the Glasgow Coma Scale and according to the Glasgow Outcome Scale (all p < 0.05). In the IPHI patients, the plasma Cys-C, D-D and hs-CRP levels were positively correlated with each other (p < 0.001). Conclusion The increase of plasma Cys-C, D-D and hs-CRP levels may be involved in IPHI after craniocerebral injury. The early detection of these indexes may help to understand the severity and outcome of IPHI.

Article Commentary: Serum C-Reactive Protein (CRP), Target for Therapy or Trouble?

High sensitivity serum C-reactive protein (hs-CRP) has come into clinical use as a marker of risk for cardiovascular disease (CVD). In addition to a role as a marker of disease, CRP has also been implicated in the pathogenesis of CVD. Specific small-molecule inhibitors of CRP have recently been developed with the intent of mitigating cardiac damage during acute myocardial infarction. However, the use of CRP, both as a risk marker and a disease target are controversial for several reasons. Serum hs-CRP concentrations can be elevated on the basis of genetics, female gender, and non-Caucasian ethnicity. It is not clear, in these contexts, that elevations of hs-CRP have any pathological significance. As a non-specific indicator of inflammation, CRP is also not a specific indicator of a single disease state such as cardiovascular disease but elevated concentrations can be seen in association with other comorbidities including obesity and pulmonary disease. In sharp contrast to the proposed inhibition of CRP for cardiovascular disease treatment, the infusion of CRP has been shown to have profound therapeutic benefits for autoimmune disease and septic shock. The balance between the risks and benefits of these competing views of the role of CRP in disease and disease therapy is reminiscent of the ongoing controversy regarding the use of non-steroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal disease and their cardiovascular side effects. Soon, NSAIDs may not be the only agents about which Rheumatologists and Cardiologists may spar.

Comparison Between Serum hsCRP and LDL Cholesterol for Search of a Better Predictor for Ischemic Heart Disease

Acute myocardial Infarction is one of the major causes of morbidity & mortality in world and atherosclerosis is the major cause of ischemic heart disease. In order to determine the better clinical marker of atherosclerosis, we estimated serum low-density lipoprotein (LDL-C) and high sensitivity C-reactive protein (hsCRP). Hundred patients of myocardial infarction and 100 controls irrespective of age and sex were studied for these parameters over a period of 2 years. The statistical analysis showed that the serum hsCRP was significantly raised in myocardial infarction cases than controls (P < 0.01) but LDL-C was not (P > 0.05). We conclude that the serum hsCRP has better predictive value for risk of atherosclerosis.

Clozapine therapy raises serum concentrations of high sensitive C-reactive protein in schizophrenic patients

Eight schizophrenic inpatients without manifest comorbidity were longitudinally studied. The aim was to find whether clozapine, the prototype of atypical antipsychotic drugs, altered their serum concentrations of high sensitive C-reactive protein (hsCRP), an inflammatory marker of high clinical importance. Following first-time therapy with clozapine, predominantly as the sole antipsychotic for 8 weeks, hsCRP profiles increased subclinically by 600%. This rise, and the Spearman correlation between hsCRP values and corresponding leukocyte counts, was statistically significant. A one-time cross-section investigation of 25 long-term clozapine patients and 25 patient controls did not show an elevation of hsCRP under clozapine after 1 year and more. It is assumed that the clozapine-evoked increase of hsCRP is part of a transient acute-phase response. The underlying inflammatory process needs clarification.

Neopterin predicts the risk for fatal ischemic heart disease in type 2 diabetes mellitus: long-term follow-up of the HUNT 1 study

AIMS

Neopterin has emerged as a novel predictor of coronary events. The study aim was to compare the predictive value of neopterin and C-reactive protein (CRP) on long-term risk for fatal ischemic heart disease (IHD) in persons with newly diagnosed diabetes compared to persons without diabetes.

METHODS AND RESULTS

In 1984-1986 a large population study, HUNT 1, was conducted in Norway. During the study, 205 patients were diagnosed with formerly unknown diabetes. A matched control group without diabetes was selected from the HUNT 1 population. Fatal IHD was registered until 2004. Blood samples were drawn at baseline and serum was analysed for neopterin and CRP. Cox regression analysis with correction for age, gender, hypertension, body mass index, established cardiovascular disease and total cholesterol was used to estimate hazard ratios (HR) for fatal IHD. In the diabetes group, neopterin and CRP were independent predictors of fatal IHD, HR 2.59 (1.11-6.01) and 2.45 (1.05-5.69), respectively. Neither CRP nor neopterin were significant predictors of fatal IHD in the control group.

CONCLUSION

In subjects with diabetes, both neopterin and CRP were independent predictors of fatal IHD, suggesting that these two markers reflect different aspects of the pathogenesis underlying fatal coronary events.

Lower is better--the contemporary concept of low-density lipoprotein lowering in the preventive management of cardiovascular risk: does this apply to all patients?

The number of multiple outcomes-based clinical trials evaluating the use of statin drugs for lowering cardiovascular risk continues to grow, incorporating patients requiring primary and secondary preventive care. This review surveys the most recently published studies and identifies both the more extensive patient population that may benefit from primary preventive care and the concept of aggressive titration of the statin drug to improve the prognosis of the patient undergoing secondary preventive care. Data on the elderly patient, the female patient, and the diabetic patient are reviewed, as are the possible mechanisms of action of the statins in modifying cardiovascular risk. The pleiotropic effects and anti-inflammatory capabilities of the drugs are also reviewed. Conclusions are drawn regarding the contemporary use of statins in the primary and secondary preventive management of patients to significantly reduce cardiovascular risk.