C-reactive protein levels and outcomes after statin therapy

Prognostic Value of Non-alcoholic Fatty Liver Disease and RCA Pericoronary Adipose Tissue CT Attenuation in Patients with Acute Chest Pain

RATIONALE AND OBJECTIVES

Pericoronary adipose tissue (PCAT) CT attenuation of right coronary artery (RCA) and non-alcoholic fatty liver disease (NAFLD) have prognostic value for major adverse cardiovascular events (MACE) in patients with coronary artery disease. However, the superior prognostic value between RCA PCAT CT attenuation and NAFLD remains unclear in patients with acute chest pain. This study is to evaluate the prognostic value of NAFLD for MACE, and further assess the incremental prognostic value of NAFLD over PCAT CT attenuation.

MATERIALS AND METHODS

Between January 2011 and December 2021, all consecutive emergency patients with acute chest pain referred for coronary CT angiography (CCTA) were retrospectively enrolled. MACE included unstable angina requiring hospitalization, coronary revascularization, non-fatal myocardial infarction, and all-cause death. Patients' baseline and CCTA characteristics, RCA PCAT CT attenuation, and the presence of NAFLD were used to evaluate risk factors of MACE using multivariable Cox regression analysis. The prognostic value of NAFLD compared to RCA PCAT CT attenuation was analyzed.

RESULTS

A total of 514 patients were enrolled (mean age, 58.36 ± 13.05 years; 310 men). During a median follow-up of 31 months, 60 patients (11.67%) experienced MACE. NAFLD (HR = 2.599, 95% CI: 1.207, 5.598, P = 0.015) and RCA PCAT CT attenuation (HR = 1.026, 95% CI: 1.001, 1.051, P = 0.038) were independent predictors of MACE. The global Chi-square analysis showed that NAFLD improved the risk of MACE more than that using clinical risk factors and CCTA metrics (59.51 vs 54.44, P = 0.024) or combined with RCA PCAT CT attenuation (63.75 vs 59.51, P = 0.040).

CONCLUSION

NAFLD and RCA PCAT CT attenuation were predictors of MACE. NAFLD had an incremental prognostic value beyond RCA PCAT CT attenuation for MACE in patients with acute chest pain. Adding CT-FFR into the risk prediction of patients with acute chest pain is worth considering.

Acidic pH promotes oxidation-induced dissociation of C-reactive protein

BACKGROUND

Circulating levels of the systemic inflammation marker C-reactive protein (CRP) have been associated with increased risk and poor outcomes of many diseases, such as cardiovascular events and cancer. Accumulating evidence has indicated that the conformational rearrangement of human pentameric CRP (pCRP) to monomeric CRP (mCRP) is a prerequisite for participation in the pathogenesis. Therefore, determining the mechanism of the dissociation of pCRP into pro-inflammatory mCRP under physiological/pathological circumstances has been intriguing.

METHODS

The effects of oxidative and acidic stress occurring in inflammation on pCRP were examined by electrophoresis, electron microscopy, protein fluorescence, neoepitope expression and endothelial cell responses.

RESULTS

Reactive oxygen species (ROS) generated by the copper-hydrogen peroxide system could rapidly induce the dissociation of CRP at mild acidic pH within four hours, but not at physiological pH of 7.4. Meanwhile, mannitol, a ROS scavenger, could not protect against dissociation, which implied that local ROS from accessible histidine residues may be crucially beneficial to the formation of mCRP in a redox-balanced microenvironment. Furthermore, mCRP generated by ROS could be reduced by DTT, which indicated the exposure of functional motif aa35-47, and showed potent proinflammatory actions on endothelial cells, comparable to mCRP generated by urea.

CONCLUSION

dissociation of pCRP to mCRP could be rapidly induced by ROS from copper- hydrogen peroxide system in dependence on mildly acidic stress regardless of a redox-balanced microenvironment.

The Clinical Significance and Potential Role of C-Reactive Protein in Chronic Inflammatory and Neurodegenerative Diseases

C-reactive protein (CRP) is an acute-phase protein synthesized by hepatocytes in response to pro-inflammatory cytokines during inflammatory/infectious processes. CRP exists in conformationally distinct forms such as the native pentameric CRP and monomeric CRP (mCRP) and may bind to distinct receptors and lipid rafts and exhibit different functional properties. It is known as a biomarker of acute inflammation, but many large-scale prospective studies demonstrate that CRP is also known to be associated with chronic inflammation. This review is focused on discussing the clinical significance of CRP in chronic inflammatory and neurodegenerative diseases, such as cardiovascular disease, type 2 diabetes mellitus, age-related macular degeneration, hemorrhagic stroke, Alzheimer’s disease, and Parkinson’s disease, including recent advances on the implication of CRP and its forms specifically on the pathogenesis of these diseases. Overall, we highlight the advances in these areas that may be translated into promising measures for the diagnosis and treatment of inflammatory diseases.

Inflammation revisited: inflammation versus resolution of inflammation following myocardial infarction

Myocardial infarction (MI) is the main cause for the progression of the left ventricle towards congestive heart failure. The optimal healing after MI requires timely induction and resolution of inflammation. Primarily, there have been a number of strategies applied to inhibit the post-MI inflammation but approaches that focus on the resolution of inflammation have sparsely been used in the treatment of heart failure. The early attempts to inhibit post-MI inflammation resulted in adverse outcomes that were realized in heart failure trials. We provide here an overview on the cyclooxygenase (COX)- and lipoxygenase (LOX)-derived lipid mediators that are either impairing or resolving the post-MI inflammation. With the evolution of lipidomics there has been emerging novel bioactive-specialized lipid mediators that promise to resolve chronic inflammation rather than promoting inhibition. The current review is focused on post-MI immune cells kinetics and the unexplored array of lipid mediators that are coordinated by COX and LOX. Thus, an emphasis on COX and LOX poses key questions and potential for the development of novel targets in the heart failure treatment strategy. This updated dynamic approach aims to fuse basic pre-clinical discoveries and translational bioactive lipid-based resolvin discoveries that could be potentially used in the clinic for the treatment of heart failure.

Dynamics of serum C-reactive protein (CRP) level and cosmophysical activity

BACKGROUND

C-reactive protein (CRP), an acute phase reactant, plays an important part in the investigation of the role of inflammation in pathology. Many cardiovascular events show significant associations with various cosmophysical parameters. The aim of this study was to investigate the relationship between the level of CRP and the levels of solar, geomagnetic (GMA), and cosmic ray activity.

METHODS

The results of 25,399 serum CRP tests carried out over a 3-year period were compared with the monthly and daily levels of solar, geomagnetic, and cosmic ray activity during the same period. The cosmophysical data were obtained from the National Oceanic Atmospheric Administration (NOAA) in the U.S. and from the Russian Academy of Science.

RESULTS

On a monthly basis, CRP levels showed no correlation with GMA (n=36, r=0.258, p=0.13), but there was a significant inverse relationship with neutron activity (r=-0.35, p=0.03). For the daily comparisons, CRP levels were significantly correlated with GMA (n=1057, r=0.97, p=0.02), and there was a significant inverse relationship with neutron activity (r=-0.97, p=0.025). Daily neutron activity was higher on days with CRP levels of 0-1.0 mg/dl (n=289) and above1.0-1.5 mg/dl (n=1213) than on days with higher CRP values (>1.5; n=23,897; p<0.0001).

CONCLUSION

The level of serum CRP, in addition to its association with inflammation, is related to the daily level of GMA and inversely to the level of neutron activity.

Optimal goals for statin use in patients with coronary artery disease

PURPOSE OF REVIEW

Coronary artery disease is the largest cause of premature death in the Western world. Lipid-lowering therapy with statins has revolutionized the management of this condition over the past decade.

RECENT DEVELOPMENTS

Successive clinical trials have lowered the treatment bar for statin therapy in patients with coronary artery disease. In addition to traditional markers of efficacy such as low-density lipoprotein cholesterol, emerging targets such as C-reactive protein are becoming recognized as important therapeutic goals.

SUMMARY

This review focuses on the important contributions to the literature during the past year and provides an expert opinion of the therapeutic goals for statin therapy.