1
|
Tang L, Li S, Guo X, Lai J, Liu P, Fang J, Liu X. Combinative predictive effect of left ventricular mass index, ratio of HDL and CRP for progression of chronic kidney disease in non-dialysis patient. Int Urol Nephrol 2024; 56:205-215. [PMID: 37204678 DOI: 10.1007/s11255-023-03624-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE This current study scrutinized the association among left ventricular mass index (LVMI), ratio of high-density lipoprotein (HDL) and C-reactive protein (CRP), and renal function. Furthermore, we examined the predictive effects of left ventricular mass index and HDL/CRP on progression of non-dialysis chronic kidney disease. METHODS We enrolled adult patients with chronic kidney disease (CKD) who were not receiving dialysis and obtained follow-up data on them. We extracted and compared data between different groups. To investigate the relationship between left ventricular mass index (LVMI), high-density lipoprotein (HDL)/C-reactive protein (CRP) levels, and CKD, we employed linear regression analysis, Kaplan-Meier analysis, and Cox proportional hazards regression analysis. RESULTS Our study enrolled a total of 2351 patients. Compared with those in the non-progression group, subjects in the CKD progression group had lower ln(HDL/CRP) levels (- 1.56 ± 1.78 vs. - 1.14 ± 1.77, P < 0.001) but higher left ventricular mass index (LVMI) values (115.45 ± 29.8 vs. 102.8 ± 26.31 g/m2, P < 0.001). Moreover, after adjusting for demographic factors, ln(HDL/CRP) was found to be positively associated with estimated glomerular filtration rate (eGFR) (B = 1.18, P < 0.001), while LVMI was negatively associated with eGFR (B = - 0.15, P < 0.001). In the end, we found that both LVH (HR = 1.53, 95% CI 1.15 to 2.05, P = 0.004) and lower ln(HDL/CRP) (HR = 1.46, 95% CI 1.08 to 1.96, P = 0.013) independently predicted CKD progression. Notably, the combined predictive power of these variables was stronger than either variable alone (HR = 1.98, 95% CI 1.5 to 2.62, P < 0.001). CONCLUSION Our study findings indicate that in pre-dialysis patients, both HDL/CRP and LVMI are associated with basic renal function and are independently correlated with CKD progression. These variables may serve as predictors for CKD progression, and their combined predictive power is stronger than that of either variable alone.
Collapse
Affiliation(s)
- Leile Tang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shaomin Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Xinghua Guo
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jiahui Lai
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Peijia Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Jia Fang
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Xun Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China.
| |
Collapse
|
2
|
Tang L, Deng Y, Lai J, Guo X, Liu P, Li S, Liu X. Predictive Effect of System Inflammation Response Index for Progression of Chronic Kidney Disease in Non-Dialyzing Patient. J Inflamm Res 2023; 16:5273-5285. [PMID: 38026247 PMCID: PMC10659112 DOI: 10.2147/jir.s432699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Scant research has been conducted on the interplay between the systemic inflammation response index (SIRI) and chronic kidney disease (CKD). The present study endeavors to meticulously scrutinize the association between SIRI and renal function. Additionally, we aim to assess its efficacy in predicting the progression of CKD in non-dialysis patients. Patients and Methods Adult patients with CKD who were not undergoing dialysis were enrolled, and follow-up data were obtained. Data from distinct groups were extracted and meticulously compared. A comprehensive analytical approach was adopted, including logistic regression analysis, Kaplan-Meier analysis, Cox proportional hazards regression analysis, and subgroup analysis. Results Our study included 1420 patients, with a mean age of 61 ± 17 years, and 63% were male. 244 (17.2%) patients experienced the progression of CKD. As the level of ln(SIRI) increased, patients tended to be older, with a higher proportion of males, and increased prevalence rates of hypertension, stroke, heart failure, and progression of CKD. Additionally, the levels of baseline creatinine and C-reactive protein were elevated, while the levels of estimated glomerular filtration rate and hemoglobin decreased. Upon adjusting for demographic and biochemical variables, logistic regression analysis indicated that ln(SIRI) was independently associated with advanced CKD in pre-dialysis patients (OR=1.59, 95% CI: 1.29-1.95, P<0.001). Moreover, Cox proportional-hazard analysis revealed that ln(SIRI) independently predicted CKD progression (HR: 1.3, 95% CI: 1.07-1.59, P=0.009). Conducting a subgroup analysis, we observed significant interactions between ln(SIRI) levels and gender (p<0.001), age (p=0.046), and hypertension (p=0.028) in relation to the progression of CKD. Conclusion Our study's findings demonstrate a significant association between SIRI and fundamental renal function, and independently establish a correlation between SIRI and the progression of CKD in pre-dialysis patients. These observations suggest that SIRI holds promise as a potential predictor for CKD progression.
Collapse
Affiliation(s)
- Leile Tang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ying Deng
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Jiahui Lai
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Xinghua Guo
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Peijia Liu
- Department of Nephrology, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Shaomin Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Xun Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| |
Collapse
|
3
|
Ding Y, Xu X. Dose-response relationship between leisure-time physical activity and biomarkers of inflammation and oxidative stress in overweight/obese populations. J Sci Med Sport 2023; 26:616-621. [PMID: 37775411 DOI: 10.1016/j.jsams.2023.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/21/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES This study aimed to analyze the dose-response relationship between leisure-time physical activity and biomarkers of inflammation and oxidative stress in overweight/obese populations and provide exercise recommendations to regulate inflammation and oxidative stress and reduce the risk of developing obesity-related diseases. DESIGN Second analysis of a cross-sectional study. METHODS A total number of 4978 overweight/obese adults were included from the 2015-2018 National Health and Nutrition Examination Survey. Multivariable regressions were conducted to investigate the dose-response relationship between leisure-time physical activity and biomarkers of inflammation and oxidative stress. Subgroup analyses based on the doses and intensities of physical activity and in different participants were performed to provide exercise recommendations. RESULTS The results demonstrated that leisure-time physical activity was negatively associated with inflammatory biomarkers in both overweight and obese populations, and positively associated with antioxidant markers in obese populations. Overweight/obese populations performing leisure-time physical activity at 660-760 min/week (dose calculated as moderate leisure-time physical activity, equals 330-380 min/week vigorous leisure-time physical activity) demonstrated the lowest levels of inflammatory markers. Vigorous leisure-time physical activity was superior to moderate one for overweight/obese populations, especially for inflammation regulation. In addition, the regulatory effect of leisure-time physical activity on inflammation was more significant in overweight/obese populations with hypertension or stroke. CONCLUSIONS The results suggest that overweight/obese populations can take vigorous-intensity leisure-time physical activity at 330-380 min/week (for example, 60 min/day, 6 days/week, metabolic equivalent = 8) to get the maximum health benefits in terms of inflammation and oxidative stress regulation.
Collapse
Affiliation(s)
- Yijian Ding
- Department of Physical Education, Nanjing University of Science & Technology, PR China
| | - Xi Xu
- Center for Molecular Metabolism, Nanjing University of Science & Technology, PR China.
| |
Collapse
|
4
|
Wu M, Zhang X, Chen J, Zha M, Yuan K, Huang K, Xie Y, Xue J, Liu X. A Score of Low-Grade Inflammation for Predicting Stroke Recurrence in Patients with Ischemic Stroke. J Inflamm Res 2021; 14:4605-4614. [PMID: 34548807 PMCID: PMC8449639 DOI: 10.2147/jir.s328383] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/28/2021] [Indexed: 01/16/2023] Open
Abstract
Background and Purpose The impact of low-grade inflammation (LGI) on stroke recurrence has not been well studied yet. We aimed to evaluate the association between LGI and stroke recurrence in patients with ischemic stroke. Methods Patients with first-ever ischemic stroke diagnosed within 72 hours of symptoms onset were consecutively recruited from the Nanjing Stroke Registry Program. C-reactive protein (CRP) level, white blood cell (WBC) count, platelet (PLT) count, and neutrophil-to-lymphocyte ratio (NLR) were conceived as low-grade inflammation biomarkers and combined into a standardized LGI score. The association of LGI score with the risk of stroke recurrence was analyzed with multivariate Cox regression models. Analyses accounting for the competing risk of stroke recurrence and death were also performed. Results Of the 1214 patients studied (median age, 61 years; male, 71.6%), 177 (14.6%) patients experienced a recurrent stroke with a median follow-up of 23.0 (interquartile ranges, 14.5-34.0) months. Patients with stroke recurrence had a higher LGI score (median, 3 versus -2; P < 0.001) than those without recurrence. The univariate analysis indicated that patients with LGI scores in the fourth quartile were more likely to have a stroke recurrence (hazard ratios [HR], 4.312; 95% confidence interval [CI], 2.675-6.952; P < 0.001). After adjusting for potential confounders, the association remained significant in the multivariate Cox regression model (HR, 4.080; 95% CI, 2.420-6.879; P < 0.001). Competing risks model and sensitivity analysis further confirmed this conclusion. Conclusion This study showed that an elevated LGI score was associated with a higher risk of stroke recurrence, independent of other vascular risk factors.
Collapse
Affiliation(s)
- Min Wu
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, People's Republic of China
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, 210002, People's Republic of China
| | - Jingjing Chen
- Department of Neurology, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China
| | - Mingming Zha
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, 210002, People's Republic of China
| | - Kang Yuan
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210000, People's Republic of China
| | - Kangmo Huang
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, 210002, People's Republic of China
| | - Yi Xie
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, 210002, People's Republic of China
| | - Jianzhong Xue
- Department of Neurology, Changshu No.2 People's Hospital, Changshu, People's Republic of China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, People's Republic of China.,Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, 210002, People's Republic of China.,Stroke Center & Department of Neurology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People's Republic of China
| |
Collapse
|
5
|
Jeon J, Lourenco J, Kaiser EE, Waters ES, Scheulin KM, Fang X, Kinder HA, Platt SR, Rothrock MJ, Callaway TR, West FD, Park HJ. Dynamic Changes in the Gut Microbiome at the Acute Stage of Ischemic Stroke in a Pig Model. Front Neurosci 2020; 14:587986. [PMID: 33343283 PMCID: PMC7744295 DOI: 10.3389/fnins.2020.587986] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022] Open
Abstract
Stroke is a major cause of death and long-term disability affecting seven million adults in the United States each year. Recently, it has been demonstrated that neurological diseases, associated pathology, and susceptibility changes correlated with changes in the gut microbiota. However, changes in the microbial community in stroke has not been well characterized. The acute stage of stroke is a critical period for assessing injury severity, therapeutic intervention, and clinical prognosis. We investigated the changes in the gut microbiota composition and diversity using a middle cerebral artery (MCA) occlusion ischemic stroke pig model. Ischemic stroke was induced by cauterization of the MCA in pigs. Blood samples were collected prestroke and 4 h, 12 h, 1 day, and 5 days poststroke to evaluate circulating proinflammatory cytokines. Fecal samples were collected prestroke and 1, 3, and 5 days poststroke to assess gut microbiome changes. Results showed elevated systemic inflammation with increased plasma levels of tumor necrosis factor alpha at 4 h and interleukin-6 at 12 h poststroke, relative to prestroke. Microbial diversity and evenness were reduced at 1 day poststroke compared to prestroke. Microbial diversity at 3 days poststroke was negatively correlated with lesion volume. Moreover, beta-diversity analysis revealed trending overall differences over time, with the most significant changes in microbial patterns observed between prestroke and 3 days poststroke. Abundance of the Proteobacteria was significantly increased, while Firmicutes decreased at 3 days poststroke, compared to prestroke populations. Abundance of the lactic acid bacteria Lactobacillus was reduced at 3 days poststroke. By day 5, the microbial pattern returned to similar values as prestroke, suggesting the plasticity of gut microbiome in an acute period of stroke in a pig model. These findings provide a basis for characterizing gut microbial changes during the acute stage of stroke, which can be used to assess stroke pathology and the potential development of therapeutic targets.
Collapse
Affiliation(s)
- Julie Jeon
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, GA, United States
| | - Jeferson Lourenco
- Department of Animal and Dairy Sciences, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States
| | - Erin E Kaiser
- Department of Animal and Dairy Sciences, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States.,Regenerative Bioscience Center, University of Georgia, Athens, GA, United States.,Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States
| | - Elizabeth S Waters
- Department of Animal and Dairy Sciences, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States.,Regenerative Bioscience Center, University of Georgia, Athens, GA, United States.,Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States
| | - Kelly M Scheulin
- Department of Animal and Dairy Sciences, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States.,Regenerative Bioscience Center, University of Georgia, Athens, GA, United States.,Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States
| | - Xi Fang
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, GA, United States
| | - Holly A Kinder
- Department of Animal and Dairy Sciences, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States.,Regenerative Bioscience Center, University of Georgia, Athens, GA, United States.,Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States
| | - Simon R Platt
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States.,Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Michael J Rothrock
- Egg Safety and Quality Research Unit, U.S. National Poultry Research Center, USDA-ARS, Athens, GA, United States
| | - Todd R Callaway
- Department of Animal and Dairy Sciences, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States
| | - Franklin D West
- Department of Animal and Dairy Sciences, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, United States.,Regenerative Bioscience Center, University of Georgia, Athens, GA, United States.,Neuroscience Program, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, United States
| | - Hea Jin Park
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, GA, United States
| |
Collapse
|
6
|
Rayasam A, Hsu M, Hernández G, Kijak J, Lindstedt A, Gerhart C, Sandor M, Fabry Z. Contrasting roles of immune cells in tissue injury and repair in stroke: The dark and bright side of immunity in the brain. Neurochem Int 2017; 107:104-116. [PMID: 28245997 DOI: 10.1016/j.neuint.2017.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 01/09/2023]
Abstract
Despite considerable efforts in research and clinical studies, stroke is still one of the leading causes of death and disability worldwide. Originally, stroke was considered a vascular thrombotic disease without significant immune involvement. However, over the last few decades it has become increasingly obvious that the immune responses can significantly contribute to both tissue injury and protection following stroke. Recently, much research has been focused on the immune system's role in stroke pathology and trying to elucidate the mechanism used by immune cells in tissue injury and protection. Since the discovery of tissue plasminogen activator therapy in 1996, there have been no new treatments for stroke. For this reason, research into understanding how the immune system contributes to stroke pathology may lead to better therapies or enhance the efficacy of current treatments. Here, we discuss the contrasting roles of immune cells to stroke pathology while emphasizing myeloid cells and T cells. We propose that focusing future research on balancing the beneficial-versus-detrimental roles of immunity may lead to the discovery of better and novel stroke therapies.
Collapse
Affiliation(s)
- Aditya Rayasam
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Martin Hsu
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Gianna Hernández
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA; Cellular and Molecular Pathology Graduate Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Julie Kijak
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Anders Lindstedt
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Christian Gerhart
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Matyas Sandor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA; Cellular and Molecular Pathology Graduate Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Zsuzsanna Fabry
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA; Cellular and Molecular Pathology Graduate Program, University of Wisconsin-Madison, Madison, WI, USA.
| |
Collapse
|
7
|
Fisher M, Vasilevko V, Cribbs DH. Mixed cerebrovascular disease and the future of stroke prevention. Transl Stroke Res 2012; 3:39-51. [PMID: 22707990 PMCID: PMC3372772 DOI: 10.1007/s12975-012-0185-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 12/16/2022]
Abstract
Stroke prevention efforts typically focus on either ischemic or hemorrhagic stroke. This approach is overly simplistic due to the frequent coexistence of ischemic and hemorrhagic cerebrovascular disease. This coexistence, termed “mixed cerebrovascular disease”, offers a conceptual framework that appears useful for stroke prevention strategies. Mixed cerebrovascular disease incorporates clinical and subclinical syndromes, including ischemic stroke, subclinical infarct, white matter disease of aging (leukoaraiosis), intracerebral hemorrhage, and cerebral microbleeds. Reliance on mixed cerebrovascular disease as a diagnostic entity may assist in stratifying risk of hemorrhagic stroke associated with platelet therapy and anticoagulants. Animal models of hemorrhagic cerebrovascular disease, particularly models of cerebral amyloid angiopathy and hypertension, offer novel means for identifying underlying mechanisms and developing focused therapy. Phosphodiesterase (PDE) inhibitors represent a class of agents that, by targeting both platelets and vessel wall, provide the kind of dual actions necessary for stroke prevention, given the spectrum of disorders that characterizes mixed cerebrovascular disease.
Collapse
Affiliation(s)
- Mark Fisher
- Department of Neurology, University of California at Irvine, Irvine, CA USA
- Department of Anatomy & Neurobiology, University of California at Irvine, Irvine, CA USA
- Department of Pathology & Laboratory Medicine, University of California at Irvine, Irvine, CA USA
- UC Irvine Medical Center, 101 The City Drive South, Shanbrom Hall Room 121, Orange, CA 92868 USA
| | | | - David H. Cribbs
- Department of Neurology, University of California at Irvine, Irvine, CA USA
- UCI MIND, University of California at Irvine, Irvine, CA USA
| |
Collapse
|
8
|
Krupinski J, Turu MM, Slevin M, Martínez-González J. Carotid plaque, stroke pathogenesis, and CRP: treatment of ischemic stroke. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 9:229-35. [PMID: 17601387 DOI: 10.1007/s11936-007-0017-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Inflammation is receiving increased attention as a cause of atherosclerosis and stroke. Several inflammatory biomarkers, and particularly high-sensitivity C-reactive protein (hsCRP), have been identified as likely predictors of the risk of a future stroke. In clinical settings, it has been consistently observed that higher concentrations of CRP are associated with larger brain infarcts, stroke severity, neurologic disability, and future vascular events. However, there is still controversy over the degree of risk conferred by elevated CRP concentrations. Some studies reported that the predictive value of CRP is moderate compared with classical risk factors and is only weakly related to cardiovascular damage after adjustment for traditional cardiovascular risk factors. CRP like many other hemostatic factors is an acute-phase protein and, therefore, it is not always clear whether its association with cerebrovascular disease reflects its contribution to atherothrombosis, its acute-phase condition, or both. Furthermore, the value of single measurements of CRP in patients with concurrent infection or other inflammatory conditions has not been established and reported data should be interpreted cautiously. Several drugs, especially hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), have been demonstrated to reduce hsCRP levels independently of their effects on plasma cholesterol. Recently, emerging therapies have been aimed at the control of blood pressure and inflammation in stroke patients. Whether a reduction of hsCRP levels could be beneficial to stroke patients remains to be clarified, and it is also unclear whether other drugs may be useful to lower hsCRP levels. More studies are needed before hsCRP becomes a routine part of the evaluation of stroke patients. This should also prompt the search for new agents directly blocking CRP actions.
Collapse
Affiliation(s)
- Jerzy Krupinski
- Department of Neurology, Stroke Unit, Hospital Universitari de Bellvitge, Feixa Llarga s/n 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | | | | |
Collapse
|
9
|
Fox ER, Benjamin EJ, Sarpong DF, Nagarajarao H, Taylor JK, Steffes MW, Salahudeen AK, Flessner MF, Akylbekova EL, Fox CS, Garrison RJ, Taylor HA. The relation of C--reactive protein to chronic kidney disease in African Americans: the Jackson Heart Study. BMC Nephrol 2010; 11:1. [PMID: 20078870 PMCID: PMC2826325 DOI: 10.1186/1471-2369-11-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 01/15/2010] [Indexed: 11/24/2022] Open
Abstract
Background African Americans have an increased incidence and worse prognosis with chronic kidney disease (CKD - estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2) than their counterparts of European-descent. Inflammation has been related to renal disease in non-Hispanic whites, but there are limited data on the role of inflammation in renal dysfunction in African Americans in the community. Methods We examined the cross-sectional relation of log transformed C-reactive protein (CRP) to renal function (eGFR by Modification of Diet and Renal Disease equation) in African American participants of the community-based Jackson Heart Study's first examination (2000 to 2004). We conducted multivariable linear regression relating CRP to eGFR adjusting for age, sex, body mass index, systolic and diastolic blood pressure, diabetes, total/HDL cholesterol, triglycerides, smoking, antihypertensive therapy, lipid lowering therapy, hormone replacement therapy, and prevalent cardiovascular disease events. In a secondary analysis we assessed the association of CRP with albuminuria (defined as albumin-to-creatinine ratio > 30 mg/g). Results Participants (n = 4320, 63.2% women) had a mean age ± SD of 54.0 ± 12.8 years. The prevalence of CKD was 5.2% (n = 228 cases). In multivariable regression, CRP concentrations were higher in those with CKD compared to those without CKD (mean CRP 3.2 ± 1.1 mg/L vs. 2.4 ± 1.0 mg/L, respectively p < 0.0001). CRP was significantly associated with albuminuria in sex and age adjusted model however not in the multivariable adjusted model (p > 0.05). Conclusion CRP was associated with CKD however not albuminuria in multivariable-adjusted analyses. The study of inflammation in the progression of renal disease in African Americans merits further investigation.
Collapse
Affiliation(s)
- Ervin R Fox
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Godoy DA, Piñero GR, Svampa S, Papa F, Di Napoli M. Early hyperglycemia and intravenous insulin-the rationale and management of hyperglycemia for spontaneous intracerebral hemorrhage patients: is time for change? Neurocrit Care 2009; 10:150-3. [PMID: 18463989 DOI: 10.1007/s12028-008-9098-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
11
|
Krupinski J, Turu MM, Slevin M, Martínez-González J. Carotid plaque, stroke pathogenesis, and CRP: treatment of ischemic stroke. Curr Cardiol Rep 2008; 10:25-30. [PMID: 18416997 DOI: 10.1007/s11886-008-0006-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
C-reactive protein (CRP), an inflammatory marker, has been identified as a likely predictor of the risk of a future stroke. In clinical settings, it has been consistently observed that higher concentrations of CRP are associated with larger brain infarcts and worst neurologic outcome. However, there is still controversy over the degree of risk conferred by elevated CRP concentrations. CRP, like many other hemostatic factors, is an acute-phase protein and, therefore, it is not always clear whether its association with cerebrovascular disease reflects its contribution to atherothrombosis, its acute-phase condition, or both. Whether a reduction of CRP levels could be beneficial to stroke patients remains to be clarified. More studies are needed before CRP becomes a routine part of the evaluation of stroke patients.
Collapse
Affiliation(s)
- Jerzy Krupinski
- Department of Neurology, Stroke Unit, Hospital Universitari de Bellvitge, Feixa Llarga s/n 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | | | | |
Collapse
|