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Arroyo-Espliguero R, Viana-Llamas MC, Silva-Obregón A, Avanzas P. The Role of C-reactive Protein in Patient Risk Stratification and Treatment. Eur Cardiol 2021; 16:e28. [PMID: 34276813 PMCID: PMC8280753 DOI: 10.15420/ecr.2020.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/15/2021] [Indexed: 11/09/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory disease. Several circulating inflammatory markers have been proposed for clinical use due to their ability to predict future cardiovascular events and may be useful for identifying people at high risk who might benefit from specific treatment to reduce this risk. Moreover, the identification of new therapeutic targets will allow the development of drugs that can help reduce the high residual risk of recurrence of cardiovascular events in patients with coronary artery disease. The clinical benefits of reducing recurrent major cardiovascular events recently shown by canakinumab and colchicine have renewed the cardiology community’s interest in inflammation as an aetiopathogenic mechanism for atherosclerosis. This review explores the use of C-reactive protein, which is the most frequently studied biomarker in this context; the concept of residual risk in primary and secondary cardiovascular prevention; and the current recommendations in international guidelines regarding the role of this inflammatory biomarker in cardiovascular risk stratification.
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Affiliation(s)
| | - María C Viana-Llamas
- Department of Cardiology, Hospital Universitario de Guadalajara Guadalajara, Spain
| | - Alberto Silva-Obregón
- Department of Intensive Medicine, Hospital Universitario de Guadalajara Guadalajara, Spain
| | - Pablo Avanzas
- Department of Cardiology, Hospital Universitario Central de Asturias Oviedo, Spain.,Department of Medicine, Universidad de Oviedo Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias Oviedo, Spain
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Fibrinogen and the Severity of Coronary Atherosclerosis among Adults with and without Statin Treatment: Lipid as a mediator. Heart Lung Circ 2016; 25:558-67. [PMID: 26839166 DOI: 10.1016/j.hlc.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/24/2015] [Accepted: 01/02/2016] [Indexed: 12/30/2022]
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3
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Correlation of NLRP3 with severity and prognosis of coronary atherosclerosis in acute coronary syndrome patients. Heart Vessels 2015; 31:1218-29. [DOI: 10.1007/s00380-015-0723-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/24/2015] [Indexed: 12/22/2022]
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Zhang Y, Zhu CG, Guo YL, Xu RX, Li S, Dong Q, Li JJ. Higher fibrinogen level is independently linked with the presence and severity of new-onset coronary atherosclerosis among Han Chinese population. PLoS One 2014; 9:e113460. [PMID: 25426943 PMCID: PMC4245131 DOI: 10.1371/journal.pone.0113460] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/26/2014] [Indexed: 01/06/2023] Open
Abstract
Background Fibrinogen is a coagulation/inflammatory biomarker strongly associated with atherogenesis. However, no data is currently available regarding the association of fibrinogen level with the presence and severity of new-onset coronary atherosclerosis assessed by Gensini score (GS), particularly in Han Chinese with a large sample size. Methods and Results We studied 2288 consecutive, new-onset subjects undergoing coronary angiography with angina-like chest pain. Clinical and laboratory data were collected. Coronary stenotic lesions were considered to be the incidence of coronary atherosclerosis. The severity of coronary stenosis was determined by the GS system. Data indicated that patients with high GS had significantly elevated fibrinogen level (p<0.001). The prevalence and severity of coronary atherosclerosis were dramatically increased according to fibrinogen tertiles. Spearman correlation analysis revealed a positive association between fibrinogen level and GS (r = 0.138, p<0.001). Multivariate logistic regression analysis demonstrated that plasma fibrinogen level was independently associated with high GS (OR = 1.275, 95% CI 1.082–1.502, p = 0.004) after adjusting for potential confounders. Moreover, fibrinogen level was also independently related to the presence of coronary atherosclerosis (fibrinogen tertile 2: OR = 1.192, 95% CI 0.889–1.598, p = 0.241; tertile 3: OR = 2.003, 95% CI 1.383–2.903, p <0.001) and high GS (fibrinogen tertile 2: OR = 1.079, 95% CI 0.833–1.397, p = 0.565; tertile 3: OR = 1.524, 95% CI 1.155–2.011, p = 0.003) in a dose-dependent manner. Receiver-operating characteristic curve analysis showed that the best fibrinogen cut-off value for predicting the severity of coronary stenosis was 3.21 g/L. Conclusions Higher fibrinogen level is independently linked with the presence and severity of new-onset coronary atherosclerosis in Han Chinese population.
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Affiliation(s)
- Yan Zhang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Rui-Xia Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Qian Dong
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
- * E-mail:
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Wen ZZ, Geng DF, Luo JG, Wang JF. Combined use of high-sensitivity C-reactive protein and apolipoprotein B/apolipoprotein A-1 ratio prior to elective coronary angiography and oral glucose tolerance tests. Clin Biochem 2011; 44:1284-91. [PMID: 21939649 DOI: 10.1016/j.clinbiochem.2011.08.1142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 08/21/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The study aimed to investigate the predictive value of the combination of high-sensitivity C-reactive protein (hs-CRP) and apolipoprotein B (apoB)/apoA-1 ratio for the outcomes of coronary angiography (CAG), echocardiography and oral glucose tolerance tests (OGTTs). DESIGN AND METHODS Hs-CRP, apoB, apoA-1, and the profiles of CAG, echocardiography and OGTTs as well as traditional risk factors were measured in 1757 cardiology patients. RESULTS Hs-CRP or apoB/apoA-1 ratio was significantly correlated with the presence and severity of angiographic profiles, the levels of left ventricular (LV) ejection fraction, LV mass and LV mass index, and the presence of abnormal glucose metabolism. The combination of hs-CRP and apoB/apoA-1 ratio had greater correlation with abnormal glucose metabolism than its individual components in patients with normal fasting glucose, and was an independent predictor for coronary artery disease. CONCLUSIONS The combination of hs-CRP and apoB/apoA-1 ratio may be a strong predictor for coronary artery disease and abnormal glucose metabolism.
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Affiliation(s)
- Zhu-zhi Wen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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6
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Shi JZ, Wang LY, Zhu Y, Zhao CY, Liu W, Jiang SL, You HW, Wang Y, Xu FY, Tang YS, Cui LQ. OX40 Ligand Levels and High-Sensitivity C-Reactive Protein Levels in Blood from Local Coronary Plaque and the Femoral Artery in Patients with Acute Coronary Syndrome or Stable Angina. J Int Med Res 2011; 39:1275-83. [PMID: 21986129 DOI: 10.1177/147323001103900415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OX40 ligand (OX40L) and high-sensitivity C-reactive protein (hs-CRP) play important roles in the pathogenesis of atherosclerosis. In this study, consecutive patients with acute coronary syndrome (ACS; n = 90) or stable angina (SA; n = 40) and healthy control subjects ( n = 50) were evaluated to assess plasma OX40L and serum hs-CRP levels in local coronary plaque and the femoral artery. OX40L and hs-CRP levels in the femoral artery were significantly higher in patients with ACS compared with controls. OX40L and hs-CRP levels in local coronary plaque (OX40Lc and hs-CRPc, respectively) were significantly higher in ACS than in SA patients. OX40L and hs-CRP levels were positively correlated with each other and were also correlated with fibrinogen levels. The number of complex lesions was correlated with OX40Lc and hs-CRPc levels. It is concluded that the OX40Lc level was highly sensitive for evaluating the inflammatory response in ACS and elevated levels of OX40Lc may be a valuable predictive marker for increased risk of atherosclerotic progression in ACS patients.
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Affiliation(s)
- JZ Shi
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - LY Wang
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Y Zhu
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - CY Zhao
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - W Liu
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - SL Jiang
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - HW You
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Y Wang
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - FY Xu
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - YS Tang
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - LQ Cui
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
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Kassem E, Ghonimy R, Adel M, El-Sharnoby G. Non traditional risk factors of carotid atherosclerosis in rheumatoid arthritis. EGYPTIAN RHEUMATOLOGIST 2011. [DOI: 10.1016/j.ejr.2011.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ma YH, Zhao L, Xian XD, Yang D, Huang W, Wang YH, Mueller O, Chang E, Konigshofer Y, Van-Cleve M, Liu G, Yang JK. A case-control study on the relationship between HDL2b and non-alcoholic fatty liver disease in Chinese type 2 diabetic patients. Clin Chem Lab Med 2009; 47:1067-72. [PMID: 19728847 DOI: 10.1515/cclm.2009.257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It has been shown that low concentrations of high-density lipoprotein cholesterol (HDL-C) are associated with non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM). HDL2b, a major subfraction of high-density lipoprotein (HDL), is more significantly correlated with coronary heart disease (CHD) compared with total HDL. In this study, we analysed HDL2b in a cohort of Chinese T2DM subjects with or without NAFLD. METHODS A highly sensitive and reliable microfluidic chip method was adopted to measure HDL2b. In total, 48 T2DM patients with NAFLD diagnosed by a B-ultrasound were enrolled from our Beijing Community Pre-Diabetes (BCPD) study cohort. A total of 48 age and gender matched diabetic controls without NAFLD were selected from the same population. RESULTS Clinical characteristics and serum biochemical analyses demonstrated a significantly increased body mass index (BMI), waist circumference, homeostasis model assessment-insulin resistant index (HOMA-IR), total cholesterol (TC), and triglyceride (TG) concentrations in the NAFLD group. However, the concentrations of HDL2b and its ratio to total HDL in NAFLD patients was decreased, compared with controls (p<0.01). Significantly increased concentrations of high sensitive C-reactive protein (hs-CRP) (p<0.01) were also found. Multifactor logistic regression analysis showed that BMI and TG were the predominant risk factors for fatty liver, while HDL2b was a protective factor. CONCLUSIONS T2DM patients with NAFLD have characteristics including obesity, marked insulin resistance, high TG, high hs-CRP, low HDL2b and a low HDL2b ratio to total HDL. These factors may increase the incidence of atherosclerosis as well as the risk of CHD.
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Affiliation(s)
- Ya-Hong Ma
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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9
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Association of inflammatory markers with angiographic severity and extent of coronary artery disease. Atherosclerosis 2009; 206:335-9. [DOI: 10.1016/j.atherosclerosis.2009.01.041] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/26/2009] [Accepted: 01/26/2009] [Indexed: 11/20/2022]
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High sensitive C-reactive protein, adiponectin, and urine albumin excretion rate in Chinese coronary artery disease patients with different glucose tolerance status. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200812020-00008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Arroyo-Espliguero R, Avanzas P, Quiles J, Kaski JC. Predictive value of coronary artery stenoses and C-reactive protein levels in patients with stable coronary artery disease. Atherosclerosis 2008; 204:239-43. [PMID: 18823889 DOI: 10.1016/j.atherosclerosis.2008.08.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 07/29/2008] [Accepted: 08/01/2008] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND AIMS Coronary occlusions resulting in acute events often occur at the site of non-severe stenoses. We sought to assess the prognostic value of non-obstructive coronary stenoses and C-reactive protein (CRP) levels in patients with chronic stable angina (CSA). METHODS We studied 790 consecutive patients with CSA who underwent routine coronary arteriography. High sensitivity CRP and coronary angiograms were assessed at study entry. Angiographic coronary disease severity was graded using a "vessel score" (number of coronary arteries showing at least 50% reduction in lumen diameter) and extent of disease with an "extension score" (proportion of the coronary artery tree showing angiographically detectable atheroma). Patients were followed up for 1 year. RESULTS Significant left main stem disease was present in 54 patients (6.8%). 368 patients (46.6%) underwent revascularization. 71 patients (9%) had at least one of the events comprised in the combined study end-point (unstable angina, myocardial infarction (AMI) and cardiac death). Patients who suffered cardiac adverse events had a significantly higher vessel score (n) (2.0 [2.0-3.0] vs. 2.0 [1.0-2.0], P<0.001), extension score (%) (23.5 [17-34.5] vs. 16.0 [6.0-27.0], P<0.001) and CRP levels (mg/L) (3.0 [1.8-7.2] vs. 2.3 [1.1-4.7], P=0.001) compared to patients without events. Age, previous history of AMI, vessel score, extension score and CRP levels were significantly associated with the study end-point. Multivariate analysis showed extension score (OR 5.3 [2.8-10.3] CI 95%; P<0.001), revascularization (OR 0.26 [0.14-0.48] CI 95%; P<0.001) and CRP levels (OR 1.9 [1.1-3.2] CI 95%; P=0.03), but not vessel score (P=0.1), to be independent predictors of the combined end-point. CONCLUSIONS In patients with CSA, independently of revascularization, extension score and CRP levels predict cardiac adverse events, regardless of the presence or absence of flow limiting coronary lesions.
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Relation between plasma adiponectin, high-sensitivity C-reactive protein, and coronary plaque components in patients with acute coronary syndrome. Am J Cardiol 2008; 101:1-7. [PMID: 18157956 DOI: 10.1016/j.amjcard.2007.07.041] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/16/2007] [Accepted: 07/16/2007] [Indexed: 11/21/2022]
Abstract
The present study investigated the relation between plasma high-sensitivity C-reactive protein (hs-CRP) and adiponectin and coronary plaque components in patients with acute coronary syndrome (ACS). Previous studies showed a pivotal role of inflammation in the progression of atherosclerosis and the prognostic value of several biomarkers. However, relations among inflammatory biomarkers and plaque characteristics were unknown. Ninety-three culprit plaques (ACS n = 50, non-ACS n = 43) and 56 nonculprit plaques (ACS n = 28, non-ACS n = 28) were analyzed using Virtual Histology intravascular ultrasound to examine relations among plasma hs-CRP, adiponectin, and ratios of each coronary plaque component. Plasma adiponectin was significantly lower and plasma hs-CRP was significantly higher in patients with than without ACS. Culprit plaques in patients with ACS had greater amounts of necrotic core plaque than those in patients without ACS. There was an inverse relation between serum hs-CRP and adiponectin with regard to necrotic core ratio in both culprit and nonculprit lesions in patients with ACS, but not those without ACS. In conclusion, increased plasma hs-CRP and hypoadiponectinemia might be related to the progression of ACS.
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Geluk CA, Post WJ, Hillege HL, Tio RA, Tijssen JGP, van Dijk RB, Arnold Dijk W, Bakker SJL, de Jong PE, van Gilst WH, Zijlstra F. C-reactive protein and angiographic characteristics of stable and unstable coronary artery disease: data from the prospective PREVEND cohort. Atherosclerosis 2006; 196:372-382. [PMID: 17157301 DOI: 10.1016/j.atherosclerosis.2006.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 10/13/2006] [Accepted: 11/10/2006] [Indexed: 11/19/2022]
Abstract
AIMS High sensitive-C-reactive protein (hs-CRP) is associated with coronary risk, which may be explained by an association with (unstable) coronary artery disease (CAD). Until now, histopathological and angiographic studies have failed to consistently demonstrate a strong relationship. However, most of these studies were limited by a cross-sectional design. Our aim was to prospectively evaluate the association between hs-CRP and plaque instability. Therefore, firstly, we investigated the relation between hs-CRP measured long before coronary angiography (CAG) and angiographic characteristics of stable and unstable CAD. In addition, we investigated the association with coronary events during follow up in the total PREVEND population. METHODS AND RESULTS Of the population based Prevention of Renal and Vascular Endstage Disease (PREVEND) study, 8139 subjects without previous documented CAD were followed for the incidence of CAG and coronary events from 1997 to 2003. For the qualitative angiographic analysis, 216 CAGs were available. Mean time to CAG was 37+/-19 months. The 864 coronary vessels were graded as follows: 436 coronary vessels as normal, 175 as non-obstructive CAD, 179 as stable obstructive CAD and 74 as unstable obstructive CAD. Multilevel ordinal regression analysis was performed to study associations between baseline clinical variables and angiographic findings. Hs-CRP contributed significantly to the multivariate model after adjustment for age, gender, smoking, lipids and blood pressure. In 8139 subjects, 201 (2.5%) first coronary events occurred during follow up. Cox survival analysis showed age- and sex-adjusted hazard ratios for hs-CRP 1-3 and >3mg/L of, respectively, 1.26 (95% CI 0.67-2.40) and 3.16 (95% CI 1.26-3.16), relative to hs-CRP <1mg/L. CONCLUSION In the prospective PREVEND study of subjects without previous documented CAD, hs-CRP levels at baseline were associated with angiographic characteristics and clinical consequences of plaque instability during follow up. This observation supports the concept that hs-CRP significantly contributes to coronary atherogenesis.
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Affiliation(s)
- Christiane A Geluk
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands.
| | - Wendy J Post
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Hans L Hillege
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands
| | - René A Tio
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - René B van Dijk
- Department of Cardiology, Martini Hospital Groningen, The Netherlands
| | - W Arnold Dijk
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Paul E de Jong
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Wiek H van Gilst
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands; Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands
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Otsuka F, Sugiyama S, Kojima S, Maruyoshi H, Funahashi T, Matsui K, Sakamoto T, Yoshimura M, Kimura K, Umemura S, Ogawa H. Plasma adiponectin levels are associated with coronary lesion complexity in men with coronary artery disease. J Am Coll Cardiol 2006; 48:1155-62. [PMID: 16978998 DOI: 10.1016/j.jacc.2006.05.054] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 05/09/2006] [Accepted: 05/16/2006] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We sought to assess whether plasma adiponectin levels correlate with angiographic coronary lesion complexity in patients with coronary artery disease (CAD). BACKGROUND Metabolic disorders, including diabetes mellitus and metabolic syndrome, are important risk factors for acute cardiovascular events, and adiponectin is a key molecule of metabolic disorders, with anti-atherogenic properties. Low plasma adiponectin levels are associated with CAD and future incidence of myocardial infarction. The involvement of adiponectin in coronary plaque vulnerability, which may be reflected by angiographic complex lesions, remains to be elucidated. METHODS We measured plasma adiponectin levels in 207 men (152 with stable CAD and 55 with acute coronary syndromes [ACS]). Coronary lesions were classified as of simple or complex appearance. RESULTS Plasma adiponectin levels were significantly lower in stable CAD patients with complex coronary lesions (n = 60) than in those with simple lesions (n = 92) (4.14 [range 2.95 to 6.02] vs. 5.27 [range 3.67 to 8.12] microg/ml, p = 0.006). Multiple logistic regression analysis demonstrated that adiponectin level was independently associated with complex lesions (odds ratio 0.514, 95% confidence interval 0.278 to 0.951; p = 0.034). Polytomous logistic regression revealed that adiponectin correlated independently with both single and multiple complex lesions. Among patients with ACS, who had lower adiponectin levels than stable CAD patients, those with multiple complex lesions had significantly lower adiponectin than those with a single complex lesion (3.26 [range 2.26 to 4.46] vs. 4.21 [range 3.36 to 5.41] microg/ml, p = 0.032). CONCLUSIONS Plasma adiponectin levels are significantly associated with coronary lesion complexity in men with CAD. Low adiponectin levels may contribute to coronary plaque vulnerability.
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Affiliation(s)
- Fumiyuki Otsuka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
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Katritsis D, Korovesis S, Karvouni E, Giazitzoglou E, Paxinos G, Haliassos A. Does diagnostic coronary angiography induce significant coronary microembolization in stable, ischemic patients? A prospective study. J Interv Cardiol 2006; 19:346-9. [PMID: 16881984 DOI: 10.1111/j.1540-8183.2006.00159.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although microembolization during percutaneous coronary interventions is a frequent event, the extent of possible microembolization during diagnostic coronary angiography is unknown. The aim of the study was to investigate whether diagnostic coronary angiography results in coronary microembolization and consequent subtle, subclinical myocardial necrosis with enzyme elevations. METHODS Fifty-three consecutive patients underwent diagnostic coronary angiography due to inducible ischemia. Creatine kinase MB isoenzyme (CK MB) and cardiac troponin I (cTnI) were used as sensitive surrogate markers of myocardial necrosis. Serial measurements, before, and 6 and 24 hours following a diagnostic procedure, were performed. RESULTS Baseline cTnI was below the limits of detection in all patients (<0.20 ng/mL), except for one patient with 1.31 ng/mL. Baseline median CK-MB was 1.05 ng/mL (interquartile range, 0.80-1.56 ng/mL) (Fig. 1). Both at 6 and 24 hours, no patients had any increase in cTnI, with the exception of a minor increase to 0.22 ng/mL at 24 hours in one patient. At 6 hours, 25 patients had decreases in CK MB, while 22 had increases (exact P = 0.77). At 24 hours, 26 patients had decreases in CK MB and 19 patients had increases. CONCLUSIONS Detectable embolization with subsequent subclinical myonecrosis is an unlikely event.
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Bernal-Mizrachi L, Jy W, Fierro C, Macdonough R, Velazques HA, Purow J, Jimenez JJ, Horstman LL, Ferreira A, de Marchena E, Ahn YS. Endothelial microparticles correlate with high-risk angiographic lesions in acute coronary syndromes. Int J Cardiol 2005; 97:439-46. [PMID: 15561331 DOI: 10.1016/j.ijcard.2003.10.029] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2003] [Revised: 09/24/2003] [Accepted: 10/14/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endothelial Microparticles (EMP) are small fragments of endothelial cell membrane shed during apoptosis or activation. Our group has previously reported elevations of EMP in patients with coronary artery disease (CAD), thrombotic thrombocytopenic purpura (TTP), pre-eclampsia, multiple sclerosis (MS), and severe hypertension (HTN). In the present study, we evaluate the possible relationship between EMP levels and the angiographic severity and characteristics of coronary obstructive lesions. METHODS We studied a total of 43 patients undergoing coronary angiography. Fifteen had presented with acute myocardial infarction (MI), 20 with unstable anginas (UA), 5 with stable angina (SA) and 3 with congestive heart failure. Coronary angiography was reviewed and coronary lesions were classified using the Ambrose classification. Coronary stenoses were classified as high and low risk. High-risk included lesions with eccentric appearance (type II), presence of thrombi, or multiple irregularities. Low-risk lesions were defined as concentric or type I. Lesions were also analyzed by degree of stenosis and history of acute coronary syndrome (ACS). EMP in plasma was assayed by flow cytometry. RESULTS EMP in eccentric type II or multiple irregular lesions (high-risk) were 2.5-fold higher than in type I or concentric (low-risk) lesions, p<0.05. Lesions with thrombi had three-fold higher EMP than those without (p=0.05). Mild stenosis (>20%-<45%) had three-fold higher EMP than more severe (>45%), and five-fold higher than those without stenosis (p<0.01). Among patients with type II lesions, those with first ACS episode had four-fold higher EMP levels than those with recurrent ACS (p<0.01). CONCLUSION High EMP was associated with high-risk angiographic lesions including eccentric type II, multiple irregular, and lesions with thrombi. Mild to moderate stenosis was associated with higher EMP levels than severe stenosis. EMP may be a useful marker in detecting endothelial injury and risk of ACS as defined by angiography.
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Affiliation(s)
- Leon Bernal-Mizrachi
- Wallace H. Coulter Platelet Laboratory, Department of Medicine, Divisions of Hematology/Oncology, School of Medicine, University of Miami, 1600 NW 10th Ave., Box R-36A (Rm. 7028), Miami, FL 33136, USA
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Moschos N, Christoforaki M, Antonatos P. Reply to mechanisms of seasonal variation of acute myocardial infarction by Tsoung O. Tseng. Int J Cardiol 2005. [DOI: 10.1016/j.ijcard.2004.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Navarro Estrada JL, Gabay JM, Alvarez J, Sztejfman C, Matas CR, Farrás A, Sarmiento R, Tettamanzi A, Rapallo C, Mrad J, Botto F, Hirschson-Prado A, De Miguel R, Guzmán LA. Relation of C-reactive protein to extent and complexity of coronary narrowing in patients with non-ST elevation acute coronary syndromes. A prospective cohort study. Coron Artery Dis 2004; 15:477-84. [PMID: 15585988 DOI: 10.1097/00019501-200412000-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inflammatory markers have been associated with adverse clinical outcome in patients with acute coronary syndromes (ACS). In addition, angiographic plaque morphology and extension of coronary artery disease has been related to worse prognosis in this group of patients. The aim of the present study was to determine if the clinical prognostic value of C-reactive protein (CRP), an inflammatory marker, can by associated with the angiographic findings in patients with non-ST elevation ACS. METHODS This prospective multicenter cohort study included 1253 patients with non-ST elevation ACS. CRP, which was considered positive (+) if >/=3 mg/l, was measured at a median of 9 h from symptoms onset and were kept blinded until the end of the study. Coronary angiography was performed in 633 patients (50%). The presence of complex coronary lesions (CCLs) was defined as the presence of any of the following: thrombus (+), Thrombolysis In Myocardial Infarction (TIMI) flow </=2, and/or ulcerated plaque (UP). The extension of coronary disease was defined as one, two or three vessel disease. RESULTS CRP was found to be (+) in 354 patients (60%). CCLs were present in 266 patients (46%), 166 (47%) in CRP (+) and 100 (42%) in CRP negative (-) patients, P=0.31. There was also no association between the extension of coronary disease and the CRP levels. CONCLUSIONS In this large consecutive cohort of non-ST elevation ACS patients, CRP, an inflammatory marker, does not predict either the extension or the complexity of coronary disease. Even though CRP is a strong predictor of worse clinical outcome in patients with ACS, this could not be explained by the angiographic anatomic findings.
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Avanzas P, Arroyo-Espliguero R, Cosín-Sales J, Quiles J, Zouridakis E, Kaski JC. Multiple complex stenoses, high neutrophil count and C-reactive protein levels in patients with chronic stable angina. Atherosclerosis 2004; 175:151-7. [PMID: 15186960 DOI: 10.1016/j.atherosclerosis.2004.03.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Revised: 02/27/2004] [Accepted: 03/22/2004] [Indexed: 11/17/2022]
Abstract
UNLABELLED Inflammation plays an important role in atherosclerosis and the genesis of acute coronary syndromes, i.e., atheromatous plaque disruption. Neutrophil count and C-reactive protein (CRP) levels are markers of ongoing inflammation and predictors of cardiovascular risk. We sought to assess whether these inflammatory markers are associated with the presence of multiple complex stenoses in patients with chronic stable angina. METHODS AND RESULTS We assessed 150 patients with chronic stable angina, 121 with significant coronary artery stenosis (> or =50% diameter reduction) and 29 without. CRP levels and neutrophil count were assessed at study entry. Stenoses were classified as "complex" (irregular or scalloped borders, ulceration or filling defects) or "smooth" (absence of complex features). Eighty-eight percent of the complex lesions were of type C according to AHA/ACC classification whereas the rest were type B. Patients with > or =3 complex lesions were considered to have multiple complex stenoses. Extent of coronary artery disease was assessed using a validated score. Baseline neutrophil count (4.39 x 10(9) L (-1) +/- 28 versus 3.82 x 10(9) L (-1) +/- 0.77; P = 0.004) and CRP levels (2.15 mg/L (4.6-1) versus 0.39 mg/L (0.69-0.23); P < 0.0001) were higher in patients with significant stenoses compared to patients without. No association was found between disease extent and CRP levels or neutrophil count. Neutrophil count, however (but not CRP) correlated with stenosis complexity (r = 0.28; P = 0.002 ) and was also an independent predictor of the presence of multiple complex stenoses (OR: 4.05; CI 95% (1.9-10.4); P = 0.038). CONCLUSIONS CRP levels and neutrophil count are higher in angina patients with coronary stenoses compared to those without. Neutrophil count, but not CRP levels, correlates with angiographic stenosis complexity.
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Affiliation(s)
- Pablo Avanzas
- Coronary Artery Disease Research Unit, Cardiological Sciences, St. George's Hospital Medical School, Cranmer Terrace, London, UK
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Sanchís J, Bodí V, Llácer Á, Facila L, Martínez-Brotons Á, Insa L, Chorro FJ. Relación de los valores de proteína C reactiva con los hallazgos angiográficos y los marcadores de necrosis en el síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2004. [DOI: 10.1016/s0300-8932(04)77122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Arroyo-Espliguero R, Avanzas P, Kaski JC. Enfermedad cardiovascular aterosclerótica: la utilidad de la proteína C reactiva en la identificación de la placa «vulnerable» y del paciente «vulnerable». Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77120-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chan AW, Bhatt DL, Chew DP, Reginelli J, Schneider JP, Topol EJ, Ellis SG. Relation of inflammation and benefit of statins after percutaneous coronary interventions. Circulation 2003; 107:1750-6. [PMID: 12665489 DOI: 10.1161/01.cir.0000060541.18923.e9] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Beyond lipid lowering, statins are known to possess antiinflammatory and antithrombotic properties. Recent studies suggested an association between statins and early reduction in death or myocardial infarction (MI) after percutaneous coronary interventions (PCIs). We sought to examine the interrelationship between inflammation, statin use, and PCI outcomes. METHODS AND RESULTS In the year 2000, 1552 consecutive United States residents underwent elective or urgent PCI at the Cleveland Clinic and were prospectively followed for 1 year. Preprocedural serum high-sensitivity C-reactive protein (hsCRP) levels were routinely measured. Patients who had statins initiated before the procedure (39.6%) had a lower median hsCRP level (0.40 versus 0.50 mg/dL, P=0.012) independent of the baseline cholesterol levels and had less frequent periprocedural MI (defined by CKMB > or =3x upper limit of normal, 5.7% versus 8.1%, P=0.038). At 1 year, statin pretreatment was predictive of survival predominantly among patients within the highest hsCRP quartile (mortality rate with statin pretreatment versus no pretreatment when hsCRP > or =1.11 mg/dL, 5.7% versus 14.8%, P=0.009). Using multivariate analysis, preprocedural hsCRP level remained an independent predictor for 1-year death or MI only in patients without statin therapy (hazard ratio, 1.32/quartile; P=0.001). After adjusting for the propensity of receiving statins, statin pretreatment was an independent predictor for 1-year survival within the highest hsCRP quartile (hazard ratio, 0.44; P=0.039). CONCLUSIONS Statin therapy before PCI is associated with a marked reduction in mortality among patients with high hsCRP levels. A hsCRP-guided strategy may improve targeting of statin therapy and clinical outcome among patients undergoing PCI.
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Affiliation(s)
- Albert W Chan
- Catheterization Laboratory, Department of Cardiology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, La 70121, USA.
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Zairis MN, Papadaki OA, Manousakis SJ, Thoma MA, Beldekos DJ, Olympios CD, Festeridou CA, Argyrakis SK, Foussas SG. C-reactive protein and multiple complex coronary artery plaques in patients with primary unstable angina. Atherosclerosis 2002; 164:355-9. [PMID: 12204808 DOI: 10.1016/s0021-9150(02)00129-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the possible association of plasma C-reactive protein (CRP) levels with the presence of angiographically multiple complex lesions (CLs) in patients with primary unstable angina (PUA). For the purpose of this study, 228 consecutive patients with PUA who underwent in-hospital catheterization were evaluated. Plasma CRP levels were measured upon patients' admission. Coronary plaques were classified as CL or non-CL according to Ambrose's criteria. There were 100 (43.9%) patients with no or one CL (</=1) and 128 (56.1%) patients with multiple CLs (>/=2). Tertiles of plasma CRP levels upon admission were significantly associated with the number of CLs on angiographic studies. In particular there was a significant gradual increase in either the number of CLs, or the presence of apparently thrombus-containing CLs with increasing of CRP tertiles. By multivariate analysis CRP was independently associated with the presence of either multiple CLs (R.R.=1.8, 95%CI=1.5-2.2, P<0.001), or angiographically apparent thrombus-containing CLs (R.R.=1.4, 95%CI=1.2-1.7, P=0.03).High plasma levels of CRP may reflect a multifocal activation of the coronary tree in patients with PUA. This finding suggests a generalized inflammatory reaction throughout the coronary tree in these patients.
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Kluft C, de Maat MPM. Sensitive markers of inflammation make it possible to study the chronic process: the rise of interest in low levels of C-reactive protein. Vascul Pharmacol 2002; 39:99-104. [PMID: 12616973 DOI: 10.1016/s1537-1891(02)00293-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Increases in baseline levels of C-reactive protein (CRP) have been consistently identified as an independent risk indicator of cardiovascular events. The measurement of the low level is robust and well established. Increases in low levels of CRP can mark low-grade continuous inflammation and hyperresponse in acute situations. In addition, CRP can exert various actions on vascular cells and activates complement thus participating in infarction pathogenesis. Various cardiovascular drugs, notably statins, can induce a marked decrease in low levels of CRP, which is indicative of their beneficial effect on inflammation. Future studies need to demonstrate whether increases in baseline levels of CRP can become a useful practical addition to risk recognition strategies and possibly may also serve as an additional surrogate endpoint in cardiovascular disease treatments.
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Affiliation(s)
- C Kluft
- Gaubius Laboratory, TNO-PG, P.O. Box 2215, 2301 CE Leiden, The Netherlands.
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Affiliation(s)
- Deepak L Bhatt
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Veselka J, Procházková S, Duchonová R, Bolomová I, Urbanová T, Tesar D, Honek T. Relationship of C-reactive protein to presence and severity of coronary atherosclerosis in patients with stable angina pectoris or a pathological exercise test. Coron Artery Dis 2002; 13:151-4. [PMID: 12131018 DOI: 10.1097/00019501-200205000-00003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND C-reactive protein (CRP) level is a sensitive marker of inflammation and a probable predictor of cardiovascular risk. The aim of this study was to assess the relationship between the presence and the extent of coronary atherosclerosis and CRP level in patients referred for coronary angiography for stable angina pectoris or a pathological exercise test. PATIENTS AND METHODS A group of 200 patients were prospectively analyzed for the relationship between the presence and extent of coronary atherosclerosis and high-sensitivity CRP. Patients with stable angina pectoris or a pathological exercise test were included. RESULTS For the whole group the CRP geometric mean was 2.92 mg/l and the median 3.0 mg/l. There was no difference between groups of patients with different extents of coronary lesions (P = 0.320, one-way analysis of variance). In patients without significant coronary disease the CRP geometric mean was 3.1 (2.28-4.21) mg/l with a variation coefficient of 118.4%; in patients with coronary artery disease the geometric mean was 2.83 (2.34-3.43) mg/l with a variation coefficient of 104.0%. The difference in CRP between both groups was not significant (P = 0.601). There was also no significant difference in CRP levels between groups of patients with and without a history of myocardial infarction (2.65 (2.08-3.36) mg/l and 3.18 (2.54-3.98) mg/l, P = 0.266) respectively. There was no correlation between the classification of angina pectoris and the logarithm of CRP level (P = 0.331). This relationship was not confirmed even in the group of patients with significant coronary artery disease (P = 0.693). CONCLUSIONS CRP level is not related to the extent or the presence of coronary atherosclerosis assessed by coronary angiography, history of myocardial infarction or class of stable angina pectoris in patients referred for coronary angiography for stable angina pectoris or a pathological exercise test.
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Affiliation(s)
- Josef Veselka
- Division of Cardiac Surgery, University Hospital Motol, Prague, Czech Republic.
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