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Habib S, Hafeez MS, Yuo TH, Subramaniam K. The Unstable Carotid Plaque. Anesthesiol Clin 2022; 40:737-749. [PMID: 36328626 DOI: 10.1016/j.anclin.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Carotid revascularization is performed to prevent cerebrovascular events in patients with symptomatic (>50%) and asymptomatic high degree (>70%) carotid stenosis. As this operation carries significant risks for perioperative stroke, careful selection of patients who will benefit from the procedure is essential. Certain plaque characteristics, including texture, are associated with increased tendency for rupture and can be used to identify high-risk patients. Medical therapy, carotid endarterectomy, and carotid stenting are the mainstays for patient management. With careful selection of patients, all anesthesia techniques (general anesthesia, monitored anesthesia care, and regional anesthesia) can be used safely for these revascularization procedures.
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Affiliation(s)
- Salim Habib
- Department of Vascular Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15143, USA
| | - Muhammad Saad Hafeez
- Department of Vascular Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15143, USA
| | - Theodore H Yuo
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15143, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, 3471 5th Avenue Ste 402, Pittsburgh, PA 15213, USA.
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Ugovšek S, Zupan J, Rehberger Likozar A, Šebeštjen M. Influence of lipid-lowering drugs on inflammation: what is yet to be done? Arch Med Sci 2022; 18:855-869. [PMID: 35832698 PMCID: PMC9266870 DOI: 10.5114/aoms/133936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/04/2021] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory disease that is associated with risk of cardiovascular events. The best-characterised and well-standardised clinical indicator of inflammation is C-reactive protein. Current evidence-based drug therapies for prevention and treatment of cardiovascular diseases are mainly focused on reduction of low-density lipoprotein cholesterol. However, these drugs do not provide sufficient protection against recurrent cardiovascular events. One of the possible mechanisms behind this recurrence might be the persistence of residual inflammation. For the most commonly used lipid-lowering drugs, the statins, their reduction of cardiovascular events goes beyond lowering of low-density lipoprotein cholesterol. Here, we review the effects of these lipid-lowering drugs on inflammation, considering statins, ezetimibe, fibrates, niacin, proprotein convertase subtilisin/kexin type 9 inhibitors, bempedoic acid, ethyl eicosapentaenoic acid and antisense oligonucleotides. We focus in particular on C-reactive protein, and discuss how the effects of the statins might be related to reduced rates of cardiovascular events.
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Affiliation(s)
- Sabina Ugovšek
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Janja Zupan
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | | | - Miran Šebeštjen
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre, Ljubljana, Slovenia
- University Medical Centre Ljubljana, Department of Cardiology, Slovenia
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3
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Is multiple sclerosis a risk factor for atherosclerosis? J Neuroradiol 2021; 48:99-103. [DOI: 10.1016/j.neurad.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/17/2019] [Accepted: 10/17/2019] [Indexed: 11/20/2022]
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Weinstein G, Lutski M, Goldbourt U, Tanne D. C-reactive protein is related to future cognitive impairment and decline in elderly individuals with cardiovascular disease. Arch Gerontol Geriatr 2017; 69:31-37. [DOI: 10.1016/j.archger.2016.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 11/24/2022]
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Fabjan TH, Hojs R. Ischemic stroke: the impact of renal dysfunction on 1-year mortality. Wien Klin Wochenschr 2015; 127 Suppl 5:S175-80. [PMID: 25787210 DOI: 10.1007/s00508-015-0705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 01/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Atherosclerosis is accelerated in patients with different stages of chronic renal failure. Renal dysfunction predicts mortality in patients with myocardial infarction and congestive heart failure. Less is known about the impact of renal dysfunction on mortality after ischemic stroke. The aim of the study was to investigate the impact of renal dysfunction on 1-year mortality. PATIENTS AND METHODS All 390 patients (207 men and 183 women) suffered from ischemic stroke in 1-year period were included in our study. Telephonic follow-up after 1 year was performed. The mean age of our patients was 71.0 ± 11.6 years, ranged from 36 to 96 years. Glomerular filtration rate (GFR) was calculated according to abbreviated Modification of Diet in Renal Disease formula. At admission and at discharge National Institutes of Health Stroke Scale (NIHSS) were performed. RESULTS The mean GFR in our patients was 66.0 ± 20.68 ml/min/1.73 m(2). There were 123 (31.5 %) deaths in 1-year period. Patients who died were older (P < 0.001), had higher NIHSS at admission and at discharge (both P < 0.001), higher high-sensitive C-reactive protein (P = 0.002), lower albumin (P < 0.001), lower GFR (P = 0.044), had more frequent atrial fibrillation (P < 0.001), and were less frequent actual smokers (P = 0.003). No differences in presence of diabetes and hypertension, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides between patients who died or survived were found. With Cox multivariable regression analysis age (P = 0.037), gender (P = 0.005), NIHSS at admission (P = 0.005) and discharge (P < 0.001), albumin (P = 0.005) and also GFR (P = 0.025) were predictors of 1-year mortality. CONCLUSIONS In patients with ischemic stroke, renal dysfunction (decreased GFR) was associated with 1-year mortality. GFR was independent predictor of mortality.
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Affiliation(s)
- Tanja Hojs Fabjan
- Department of Neurology, University Clinical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia. .,Faculty of Medicine, University of Maribor, Maribor, Slovenia.
| | - Radovan Hojs
- Clinic for Internal Medicine, Department of Nephrology, University Clinical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Liao H, Li Z, Zheng D, Liu J, Liu Y, Xiao C, Wang H. Increased Hs-CRP/adiponectin ratio is associated with increase carotid intima-media thickness. Lipids Health Dis 2014; 13:120. [PMID: 25070472 PMCID: PMC4123247 DOI: 10.1186/1476-511x-13-120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/23/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND High sensitivity C-reactive protein (Hs-CRP) and adiponectin (APN) are two critical cytokines and exert inverse effects on atherosclerosis initiation and progression. The purpose of our study was to investigate the value of Hs-CRP and ANP ratio (Hs-CRP/APN ratio) on evaluating atherosclerosis progression. METHOD One hundred sixty consecutive participants underwent carotid intima-media thickness (CIMT) measured by ultrasound were enrolled and drawn fasting blood samples for plasma levels Hs-CRP and APN, serum levels of lipid profiles and fasting blood glucose evaluation. Other anthropometrics and clinical status were collected by questionnaire. All participants were divided into 4 groups according to the baseline Hs-CRP/APN ratio and underwent CIMT measurement every 6 months. CIMT increment and composite cardiovascular endpoints were compared after 24 months' follow-up. RESULTS At baseline, body mass index (BMI), smoking, diabetic mellitus, usage of statins, Hs-CRP and APN independently correlated with Hs-CRP/APN ratio as analyzed by spearman rank correlation. Smoking, serum level of LDL-C, plasma level of Hs-CRP and Hs-CRP/APN ratio were positively correlated with CIMT while usage of statins and plasma level of APN were negatively correlated with CIMT as analyzed by multiple linear regression analysis. After 24 months' follow-up, the progression of CIMT was the most prominent in the fourth quartile of baseline Hs-CRP/APN ratio. In addition, the incidence of composite cardiovascular endpoint was also higher in the fourth quartile as compared to the other 3 lower quartiles. CONCLUSION Hs-CRP/APN ratio was a useful predictor to discriminate subjects who were at increased risk of atherosclerosis progression.
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Affiliation(s)
- Huocheng Liao
- Department of Cardiology, the 3rd People’s Hospital, Huizhou, China
| | - Zhiming Li
- Department of Cardiology, Huizhou Municipal Central Hospital, 41st Eling North RD, Huicheng District, Huizhou, China
| | - Dongdan Zheng
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianping Liu
- Department of Cardiology, the 3rd People’s Hospital, Huizhou, China
| | - Yan Liu
- Department of Cardiology, the 3rd People’s Hospital, Huizhou, China
| | - Chun Xiao
- Department of Cardiology, the 3rd People’s Hospital, Huizhou, China
| | - Hongguang Wang
- Internal Medicine-Cardiovascular Department, Dongying People’s Hospital of Shandong Province, NO.137, Nanyi Road, Dongying, Shangdong Province, China
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Grandner MA, Buxton OM, Jackson N, Sands-Lincoln M, Pandey A, Jean-Louis G. Extreme sleep durations and increased C-reactive protein: effects of sex and ethnoracial group. Sleep 2013; 36:769-779E. [PMID: 23633760 DOI: 10.5665/sleep.2646] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
STUDY OBJECTIVES We hypothesize that extremes of sleep duration are associated with elevated C-reactive protein (CRP), a pro-inflammatory marker for cardiovascular disease risk. DESIGN Cross-sectional. SETTING Population-based research. PARTICIPANTS Nationally representative sample of 2007-2008 National Health and Nutrition Examination Survey participants (n = 5,587 adults). INTERVENTIONS None. MEASUREMENTS AND RESULTS Associations between CRP and self-reported total sleep time (TST) were examined. Explanatory models considered contributions of sex, age, race/ethnicity, body mass index (BMI), and BMI squared (BMI2). Models also explored the role of insomnia symptoms, sleep apnea, active medical illness, and antidiabetic/antihypertensive treatment. Differential patterns among race/ethnicity groups were examined using interactions and stratified analyses. Nonlinear relationships between CRP and TST were assessed using polynomial and multinomial regression models (< 5, 5, 6, 7, 8, 9, and > 9 h). Linear and squared terms were significant in all models in the complete sample, with notable differences by sex and ethnoracial group. Overall, in models adjusted for sociodemographics and BMI, different patterns were observed for non-Hispanic white (elevated CRP for < 5 h and > 9 h), black/African-American (elevated CRP for < 5 h and 8 h), Hispanic/Latino (elevated CRP for > 9 h), and Asian/ Other (higher in 9 and > 9 h and lower in 5 h and 6 h) groups. Ethnoracial groups also demonstrated patterning by sex. CONCLUSION In a representative sample of American adults, elevated CRP was associated with extreme sleep durations. Sex, race/ethnicity, sleep disorders, and medical comorbidity influenced these associations. Differences in CRP along these dimensions should be considered in future research on sleep related disparities influencing cardiometabolic disease risk.
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Affiliation(s)
- Michael A Grandner
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Toprak A, Kandavar R, Toprak D, Chen W, Srinivasan S, Xu JH, Anwar A, Berenson GS. C-reactive protein is an independent predictor for carotid artery intima-media thickness progression in asymptomatic younger adults (from the Bogalusa Heart Study). BMC Cardiovasc Disord 2011; 11:78. [PMID: 22208681 PMCID: PMC3264529 DOI: 10.1186/1471-2261-11-78] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 12/30/2011] [Indexed: 11/29/2022] Open
Abstract
Background Conflicting information exists regarding the association between hsCRP and the progression of early stages of atherosclerosis. The purpose of the study was to investigate the association of high sensitiviy c-reactive protein (hsCRP) along with major cardiovascular (CV) risk factors on early carotid atherosclerosis progression in a large, population-based cohort study. Methods The study cohort included 839 young adults (aged 24 to 43 years, 70% white, 42% men) enrolled in Bogalusa Heart Study, who in 2001-2002 attended baseline examination with measurements of CV risk factors. Progression of carotid artery intima-media thickness (IMT) was assessed during a mean follow-up of 2.4 years. Results Carotid artery IMT progression rates were as follows: composite carotid artery = 9.2 ± 52 μm/y, common carotid artery = 0.0 ± 51 μm/y, carotid bulb = 8.8 ± 103 μm/y, and internal carotid artery = 18.9 ± 81 μm/y. Elevated baseline hsCRP, reflecting an inflammatory state, showed independent association with composite carotid artery IMT progression. Increased age, systolic blood pressure, fasting glucose, LDL cholesterol, and current smoking were other risk associates of carotid artery IMT progression in young adults, indicating an underlying burden on the CV system by multiple risk factors. Conclusion In this population-based study, we observed independent categorical association of increased hsCRP with carotid artery IMT progression in young adults. This study underlines the importance of assesssing hsCRP levels along with smoking and traditional CV risk factor profiles in asymptomatic young adults.
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Affiliation(s)
- Ahmet Toprak
- Tulane Center for Cardiovascular Health, New Orleans, LA, USA
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Avgerinos ED, Kadoglou NPE, Moulakakis KG, Giannakopoulos TG, Liapis CD. Current role of biomarkers in carotid disease: a systematic review. Int J Stroke 2011; 6:337-45. [PMID: 21745345 DOI: 10.1111/j.1747-4949.2011.00623.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Accumulating evidence suggests that carotid plaque vulnerability can be used as a determinant of ischemic stroke risk stratification and carotid intervention. Novel markers of high-risk carotid plaque in patients are needed. SUMMARY OF REVIEW Advances in cellular and molecular pathophysiology, the demand for accurately predicting carotid risk, and choosing the optimal prevention strategy are stimulating great interest in the development of novel surrogate markers. Biomarkers in cardiovascular disease are expected to predict the natural history, clinical outcomes, and the efficacy of disease-modifying interventions. We aimed to review the literature regarding clinical data on novel serum biomarkers related to ischemic cerebrovascular events associated with carotid artery disease. We provide background information on the biomarkers related to all aspects of carotid disease: natural history, carotid intervention strategies for symptomatic and asymptomatic patients, perioperative risk prediction, and their therapeutic implications. CONCLUSION At present, heterogeneous data support evidence that biological markers can help existing practices to more accurately assess patients at risk for stroke. Randomized-controlled trials for carotid artery disease and carotid intervention, incorporating biomarkers, are needed.
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Affiliation(s)
- Efthimios D Avgerinos
- Department of Vascular Surgery, Attikon University Hospital, Medical School, Athens, Greece
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Bharosay A, Saxena K, Varma M, Bharosay VV, Pandey A. Correlation between proinflammatory serum markers: high sensitivity C-reactive protein, interleukin-6 with disability score in acute ischemic stroke. Indian J Clin Biochem 2011; 26:279-82. [PMID: 22754193 PMCID: PMC3162955 DOI: 10.1007/s12291-011-0135-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 04/17/2011] [Indexed: 10/18/2022]
Abstract
Stroke being the third leading cause of death and foremost cause of disability, if potential diagnostic utility of blood borne protein biomarkers in predicting acute stroke is established, it would be a substantial adjunct to computerized tomography and magnetic resonance imaging which have their own limitations. This study was done to correlate serum Interleukin 6, high sensitivity C reactive protein at the time of admission with neurological worsening assessed by NIHSS at the time of admission and 7 days after admission. 46 Patients admitted in neurology department SAIMS, Indore with first ever ischemic stroke within 72 h of onset were included in the study. All patients with history of stroke of more than 72 h onset, Infection & peripartum stroke were excluded from the study. Disability scoring was done by NIHSS and their serum samples assayed for hsCRP, IL6 by commercially available quantitative sandwich enzyme-linked immunoadsorbent assay kits. Serum samples of 50 control cases which included healthy volunteers and staff from SAIMS were also analyzed for hsCRP, IL6 for comparative study. A significant correlation was observed between NIHSS scoring and serum hsCRP and IL6 at the time of admission. Patients with initial high serum IL6 and hsCRP also showed significant clinical deterioration as assessed by NIHSS scoring 7 days after admission. Elevated hsCRP and IL6 within 72 h of admission strongly correlated with functional disability in study population in India and may serve as useful adjunct to CT Scan in emergency setting.
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Affiliation(s)
- Anuradha Bharosay
- Department of Biochemistry, Sri Aurobindo Institute of Medical Sciences, Indore, MP 452001 India
- C/O Mr Sudhir Raizada, 95, Geeta Nagar, Opposite Shishukunj School, Indore, MP 452001 India
| | - Kiran Saxena
- College of Medical Sciences, Amargarh, District Bhavnagar, Indore, MP India
| | - Meena Varma
- Department of Biochemistry, Sri Aurobindo Institute of Medical Sciences, Indore, MP 452001 India
| | - Vivek Vikram Bharosay
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, MP India
| | - Aparna Pandey
- Department of Biochemistry, Sri Aurobindo Institute of Medical Sciences, Indore, MP 452001 India
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Selvarajah JR, Smith CJ, Hulme S, Georgiou R, Sherrington C, Staniland J, Illingworth KJ, Jury F, Payton A, Ollier WE, Vail A, Rothwell NJ, Hopkins SJ, Tyrrell PJ. Does Inflammation Predispose to Recurrent Vascular Events after Recent Transient Ischaemic Attack and Minor Stroke? the North West of England Transient Ischaemic Attack and Minor Stroke (NORTHSTAR) Study. Int J Stroke 2011; 6:187-94. [DOI: 10.1111/j.1747-4949.2010.00561.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background and hypothesis Inflammation is implicated in the pathogenesis and outcome of ischaemic injury. Poststroke inflammation is associated with outcome but it remains unclear whether such inflammation precedes or results from ischaemic injury. We hypothesised that inflammatory markers are associated with an increased risk of recurrent vascular events soon after transient ischaemic attack and minor stroke. Methods This was a multicentre, prospective, nested case–control study. Plasma concentrations of C-reactive protein, interleukin-6, interleukin-1-receptor antagonist and fibrinogen, leucocyte counts, erythrocyte sedimentation rate and inflammatory gene allele frequencies were analysed in 711 patients with recent transient ischaemic attack or minor stroke. Cases were defined by the incidence of one or more recurrent vascular events during the three-month follow-up. Association of inflammatory markers with case-status was determined using conditional logistic regression. Results Plasma concentrations of C-reactive protein, interleukin-1-receptor antagonist and interleukin-6 were not associated with case-status. In secondary analyses, only erythrocyte sedimentation rate was significantly associated with case-status (odds ratio 1·39, 95% confidence interval 1·03–1·85; P=0·03), but this effect did not persist after adjustment for smoking and past history of transient ischaemic attack or stroke. Single nucleotide polymorphisms in four inflammatory genes (interleukin-6, fibrinogen, P-selectin and vascular cell adhesion molecule-1) were nominally associated with case-status. Conclusions Circulating inflammatory markers were not associated with recurrent vascular events. Nominally significant associations between genetic markers and case-status will require replication. These data provide little evidence for an inflammatory state predisposing to stroke and other vascular events in a susceptible population.
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Affiliation(s)
| | - Craig J. Smith
- Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | - Sharon Hulme
- School of Biomedicine, The University of Manchester, UK
| | | | | | - John Staniland
- Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | | | - Francine Jury
- Centre for Integrated Genomic Medical Research, The University of Manchester, Manchester, UK
| | - Antony Payton
- Centre for Integrated Genomic Medical Research, The University of Manchester, Manchester, UK
| | - William E. Ollier
- Centre for Integrated Genomic Medical Research, The University of Manchester, Manchester, UK
| | - Andy Vail
- Health Methodology Research Group, The University of Manchester, UK
| | | | | | - Philippa J. Tyrrell
- Salford Royal Hospitals NHS Foundation Trust, Salford, UK
- School of Biomedicine, The University of Manchester, UK
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Hiukka A, Maranghi M, Matikainen N, Taskinen MR. PPARalpha: an emerging therapeutic target in diabetic microvascular damage. Nat Rev Endocrinol 2010; 6:454-63. [PMID: 20567246 DOI: 10.1038/nrendo.2010.89] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The global pandemic of diabetes mellitus portends an alarming rise in the prevalence of microvascular complications, despite advanced therapies for hyperglycemia, hypertension and dyslipidemia. Peroxisome proliferator-activated receptor alpha (PPARalpha) is expressed in organs affected by diabetic microvascular disease (retina, kidney and nerves), and its expression is regulated specifically in these tissues. Experimental evidence suggests that PPARalpha activation attenuates or inhibits several mediators of vascular damage, including lipotoxicity, inflammation, reactive oxygen species generation, endothelial dysfunction, angiogenesis and thrombosis, and thus might influence intracellular signaling pathways that lead to microvascular complications. PPARalpha has emerged as a novel target to prevent microvascular disease, via both its lipid-related and lipid-unrelated actions. Despite strong experimental evidence of the potential benefits of PPARalpha agonists in the prevention of vascular damage, the evidence from clinical studies in patients with diabetes mellitus remains limited. Promising findings from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study on microvascular outcomes are countered by elevations in participants' homocysteine and creatinine levels that might potentially attenuate the benefits of PPARalpha activation. This Review focuses on the role of PPARalpha activation in diabetic microvascular disease and highlights the available experimental and clinical evidence from studies of PPARalpha agonists.
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Affiliation(s)
- Anne Hiukka
- Division of Cardiology, Department of Medicine, Helsinki University Central Hospital and Biomedicum, Haartmaninkatu 8, 00029 Helsinki, Finland
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Xu CB, Sun Y, Edvinsson L. Cardiovascular risk factors regulate the expression of vascular endothelin receptors. Pharmacol Ther 2010; 127:148-55. [DOI: 10.1016/j.pharmthera.2010.04.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
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Kadoglou NPE, Avgerinos ED, Liapis CD. An update on markers of carotid atherosclerosis in patients with Type 2 diabetes. Biomark Med 2010; 4:601-9. [DOI: 10.2217/bmm.10.79] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Carotid atherosclerosis constitutes an important cause of ischemic brain attack and stroke, accounting for up to 40% of cases of ischemic cerebrovascular disease. Type 2 diabetes mellitus is an independent risk factor for stroke and its recurrence. Thus, identifying diabetic patients who are at high risk of developing stroke is of great clinical importance. Noninvasive measurements of surrogate markers of atherosclerosis, such as novel serum biomarkers, can be helpful in detecting subclinical carotid disease, especially among individuals at the highest cardio-/cerebro-vascular risk. Previous studies have proposed an expanding body of serum biomarkers, such as C-reactive protein, fibrinogen, adipokines, cytokines and growth factors, as novel indicators of carotid atherosclerosis development that predict carotid-related clinical outcomes. Furthermore, those biomarkers are expected to assess the efficacy of both pharmaceutical and interventional strategies. Accordingly, it is increasingly clear that measuring biomarkers may improve the definition of cerebrovascular risk profile in patients with Type 2 diabetes mellitus.
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Affiliation(s)
| | - Efthimios D Avgerinos
- Department of Vascular Surgery, Attikon University Hospital, Medical School, Athens, Greece
| | - Christos D Liapis
- Department of Vascular Surgery, Attikon University Hospital, Medical School, Athens, Greece
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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.
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Affiliation(s)
- Jerzy Krupinski
- Department of Neurology, Stroke Unit, Hospital Universitari de Bellvitge, Feixa Llarga s/n 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
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Washida N, Wakino S, Hayashi K, Kuwahara T, Itoh H. Brachial-ankle pulse wave velocity predicts silent cerebrovascular diseases in patients with end-stage renal diseases. J Atheroscler Thromb 2010; 17:165-72. [PMID: 20124736 DOI: 10.5551/jat.2097] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Cerebrovascular disease (CVD) is a major determinant of the prognosis in end-stage renal diseases (ESRD). The purpose of this study was to examine whether factors associated with arterial stiffness contributed to the development of CVD in patients with ESRD. METHODS CVD (lacunes and carotid/intracranial artery stenosis) was evaluated with brain magnetic resonance imaging (MRI), and carotid/intracranial artery magnetic resonance angiography (MRA) in 44 pre-dialytic patients. The severity of CVD was evaluated by the number of lacunes and the degree of stenosis, respectively. The association between CVD and atherosclerotic parameters was evaluated. RESULTS Patients with severe lacunes (n=18) manifested older age, lower diastolic blood pressure, serum creatinine and albumin, and higher CRP and serum calcium than those with absent-moderate lacunes (n=26). When assessed by multivariate analysis, only baPWV was adopted as an independent risk factor for severe lacunes. Furthermore, baPWV and i-PTH were associated with the severity of carotid/intracranial artery stenosis, both of which were independent of other risk factors, including age and diabetes. CONCLUSIONS Arterial stiffness may constitute a novel determinant predicting the severity of CVD in pre-dialytic patients besides classical risk factors.
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Affiliation(s)
- Naoki Washida
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
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17
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Lee HJ, Her SH, Im YS, Won KY, Yoo SH, Kim DB, Shin DI, Kim PJ, Seung KB, Kim JH, Kim KY. Significance of inflammatory markers in diabetic patients with stable coronary artery disease. Korean J Intern Med 2009; 24:212-9. [PMID: 19721857 PMCID: PMC2732780 DOI: 10.3904/kjim.2009.24.3.212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 03/16/2009] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Patients with diabetes are prone to coronary artery disease (CAD); however, the majority of diabetic patients show normal coronary arteries. We examined differences in the clinical aspects of diabetic patients with insignificant and with significant stenosis of the coronary artery. METHODS A total of 418 consecutive diabetic patients with stable angina who had undergone coronary angiography from January 2004 to March 2007 were included in this study. Patients were subdivided into control and CAD groups and then clinical characteristics and CAD-associated factors were evaluated. RESULTS A total of 92 (22%) patients were assigned to the control group and 326 (78%) patients were assigned to the CAD group. Using univariate regression analysis, we found that patients with CAD were significantly older (control vs. CAD; 59+/-21 vs. 64.7+/-33.7, years, p<0.001), had a longer duration of diabetes (8.2+/-21.8 vs. 10.2+/-29.8, years, p=0.027), higher titers of high sensitivity C-reactive protein (hsCRP; 0.3+/-6.79 vs. 0.9+/-12.6, mg/dL, p=0.015), and increased hemoglobin A1c (HbA1c) levels (7.1+/-3.8 vs. 7.5+/-4.8, %, p=0.007) compared to control patients. Multivariate regression analysis showed that only differences in age, hsCRP, and HbA1c were statistically significant. When patients were subdivided into groups based on hsCRP levels (208 patients in the low group [49.8%], 210 patients in the high group [50.2%]), we found that patients with higher hsCRP levels showed more frequent multivessel disease. CONCLUSIONS In diabetic patients, age, hsCRP, and HbA1c were associated with stable CAD. Among these factors, hsCRP levels were significantly correlated with multivessel involvement in diabetic CAD. Therefore, high hsCRP levels may be a strong predictor for atherosclerotic progression of the coronary arteries in diabetic patients, suggesting that regular screening tests should be performed.
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Affiliation(s)
- Hyo-Jin Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung-Ho Her
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yun-Sun Im
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kang-Yeon Won
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sun-Hong Yoo
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong-Bin Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong-Il Shin
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Pum-Joon Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki-Bae Seung
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae-Hyung Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Keon-Yeop Kim
- Division of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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18
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19
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Xu G, Zhao W, Zhou Z, Zhang R, Zhu W, Liu X. Danshen extracts decrease blood c reactive protein and prevent ischemic stroke recurrence: a controlled pilot study. Phytother Res 2009; 23:1721-5. [DOI: 10.1002/ptr.2819] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Whiteley W, Chong WL, Sengupta A, Sandercock P. Blood markers for the prognosis of ischemic stroke: a systematic review. Stroke 2009; 40:e380-9. [PMID: 19286602 DOI: 10.1161/strokeaha.108.528752] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The performance of validated prognostic clinical models in acute ischemic stroke might be improved by addition of data on blood biomarkers. METHODS We searched Medline and EMBASE from 1966 to January 2007 for studies of blood markers in patients with ischemic stroke and an assessment of outcome (death, disability, or handicap). We adopted several strategies to reduce bias. RESULTS Studies were generally small (median number of subjects, 85; interquartile range, 49 to 184). Few had evidence of a sample size calculation (7 of 82 [9%]) or reported blinding to whether patients had stroke (21 of 82 [26%]). Of the 66 studies reporting a measure of association, 10 did not adjust for age or stroke severity, 14 adjusted for age, 7 adjusted for severity, and 35 adjusted for both; 30% (20 of 66) used a data-dependent threshold to predict good or bad outcome. There was evidence of within-study reporting bias and publication bias. Cardiac markers showed the most consistent association with poor outcome. CONCLUSIONS Blood biomarkers might provide useful information to improve the prediction of outcome after acute ischemic stroke. However, this review showed that many studies were subject to bias. Although some markers had some predictive ability, none of the studies was able to demonstrate that the biomarker added predictive power to a validated clinical model. The clinical usefulness of blood biomarkers for predicting prognosis in the setting of ischemic stroke has yet to be established.
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Affiliation(s)
- William Whiteley
- Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK.
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21
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Abstract
Inflammatory and immune responses play important roles following ischaemic stroke. Inflammatory responses contribute to damage and also contribute to repair. Injury to tissue triggers an immune response. This is initiated through activation of the innate immune system. In stroke there is microglial activation. This is followed by an influx of lymphocytes and macrophages into the brain, triggered by production of pro-inflammatory cytokines. This inflammatory response contributes to further tissue injury. There is also a systemic immune response to stroke, and there is a degree of immunosuppression that may contribute to the stroke patient's risk of infection. This immunosuppressive response may also be protective, with regulatory lymphocytes producing cytokines and growth factors that are neuroprotective. The specific targets of the immune response after stroke are not known, and the details of the immune and inflammatory responses are only partly understood. The role of inflammation and immune responses after stroke is twofold. The immune system may contribute to damage after stroke, but may also contribute to repair processes. The possibility that some of the immune response after stroke may be neuroprotective is exciting and suggests that deliberate enhancement of these responses may be a therapeutic option.
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Affiliation(s)
- P A McCombe
- Department of Neurology, Royal Brisbane and Women's Hospital and Neuroimmunology Research Unit, Central Clinical School, University of Queensland, Brisbane, Australia.
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22
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Long-Term Effects of Fenofibrate on Carotid Intima-Media Thickness and Augmentation Index in Subjects With Type 2 Diabetes Mellitus. J Am Coll Cardiol 2008; 52:2190-7. [DOI: 10.1016/j.jacc.2008.09.049] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/22/2008] [Accepted: 09/29/2008] [Indexed: 11/17/2022]
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23
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Admission C-Reactive Protein Does Not Predict Functional Outcomes in Patients with Strokes in a Subacute Rehabilitation Unit. Am J Phys Med Rehabil 2008; 87:731-9. [DOI: 10.1097/phm.0b013e31818380ae] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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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.
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Affiliation(s)
- Jerzy Krupinski
- Department of Neurology, Stroke Unit, Hospital Universitari de Bellvitge, Feixa Llarga s/n 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
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25
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Larsson SC, Männistö S, Virtanen MJ, Kontto J, Albanes D, Virtamo J. Coffee and Tea Consumption and Risk of Stroke Subtypes in Male Smokers. Stroke 2008; 39:1681-7. [DOI: 10.1161/strokeaha.107.504183] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Coffee and tea consumption could potentially reduce the risk of stroke because these beverages have antioxidant properties, and coffee may improve insulin sensitivity. We examined the associations of coffee and tea consumption with risk of stroke subtypes.
Methods—
We used prospective data from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a cohort study of 26 556 male Finnish smokers aged 50 to 69 years without a history of stroke at baseline. Coffee and tea consumption was assessed at baseline using a validated food-frequency questionnaire. During a mean follow-up of 13.6 years, from 1985 through December 2004, 2702 cerebral infarctions, 383 intracerebral hemorrhages, and 196 subarachnoid hemorrhages were ascertained from national registries.
Results—
After adjustment for age and cardiovascular risk factors, both consumption of coffee and tea was statistically significantly inversely associated with the risk of cerebral infarction but not intracerebral or subarachnoid hemorrhage. The multivariate relative risk of cerebral infarction for men in the highest category of coffee consumption (≥8 cups/d) was 0.77 (95% CI, 0.66 to 0.90;
P
for trend <0.001) compared with those in the lowest category (<2 cups/d). The corresponding relative risk comparing men in the highest category of tea consumption (≥2 cups/d) with those in the lowest category (nondrinkers) was 0.79 (95% CI, 0.68 to 0.92;
P
for trend=0.002).
Conclusions—
These results suggest that high consumption of coffee and tea may reduce the risk of cerebral infarction among men, independent of known cardiovascular risk factors.
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Affiliation(s)
- Susanna C. Larsson
- From National Institute of Environmental Medicine (S.C.L), Karolinska Institutet, Stockholm, Sweden; the Department of Health Promotion and Chronic Disease Prevention (S.M., M.J.V., J.K., J.V.), National Public Health Institute, Helsinki, Finland; and National Cancer Institute (D.A.), National Institute of Health, Bethesda, Md
| | - Satu Männistö
- From National Institute of Environmental Medicine (S.C.L), Karolinska Institutet, Stockholm, Sweden; the Department of Health Promotion and Chronic Disease Prevention (S.M., M.J.V., J.K., J.V.), National Public Health Institute, Helsinki, Finland; and National Cancer Institute (D.A.), National Institute of Health, Bethesda, Md
| | - Mikko J. Virtanen
- From National Institute of Environmental Medicine (S.C.L), Karolinska Institutet, Stockholm, Sweden; the Department of Health Promotion and Chronic Disease Prevention (S.M., M.J.V., J.K., J.V.), National Public Health Institute, Helsinki, Finland; and National Cancer Institute (D.A.), National Institute of Health, Bethesda, Md
| | - Jukka Kontto
- From National Institute of Environmental Medicine (S.C.L), Karolinska Institutet, Stockholm, Sweden; the Department of Health Promotion and Chronic Disease Prevention (S.M., M.J.V., J.K., J.V.), National Public Health Institute, Helsinki, Finland; and National Cancer Institute (D.A.), National Institute of Health, Bethesda, Md
| | - Demetrius Albanes
- From National Institute of Environmental Medicine (S.C.L), Karolinska Institutet, Stockholm, Sweden; the Department of Health Promotion and Chronic Disease Prevention (S.M., M.J.V., J.K., J.V.), National Public Health Institute, Helsinki, Finland; and National Cancer Institute (D.A.), National Institute of Health, Bethesda, Md
| | - Jarmo Virtamo
- From National Institute of Environmental Medicine (S.C.L), Karolinska Institutet, Stockholm, Sweden; the Department of Health Promotion and Chronic Disease Prevention (S.M., M.J.V., J.K., J.V.), National Public Health Institute, Helsinki, Finland; and National Cancer Institute (D.A.), National Institute of Health, Bethesda, Md
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26
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Abstract
Overwhelming evidence now shows that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (ie, statins) are safe and effective in primary and secondary prevention of cardiovascular disease. Atherosclerosis, the primary cause of heart disease, is directly and independently related to hypercholesterolemia and inflammation, and statins have multiple and independent effects on these conditions. New evidence for the use of statins in neurologic disease is mounting, and the range of therapeutic applications is formidable. Statins are beginning to show benefits in a wide range of neurologic conditions, from common ischemic stroke to rare congenital neurometabolic storage diseases, from acute brain injury to chronic central nervous system inflammation, and from prevention of neurodegenerative disease to acute neuroprotection. A diverse therapeutic spectrum is explained by shared pathogenetic mechanisms of neurologic disease and the manifold pharmacodynamic effects of statins.
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Affiliation(s)
- J David Orr
- Neurology Associates of Arlington, 2800 E. Broad Street, Mansfield, TX 76063, USA.
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27
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Dhamija RK, Arora S, Gaba P, Jais M, Kaintura A, Kumar M, Bhattacharjee J. Study of genetic, metabolic and inflammatory risk factors in patients of acute ischemic stroke. Indian J Clin Biochem 2008; 23:136-43. [DOI: 10.1007/s12291-008-0031-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Arthurs ZM, Andersen C, Starnes BW, Sohn VY, Mullenix PS, Perry J. A prospective evaluation of C-reactive protein in the progression of carotid artery stenosis. J Vasc Surg 2008; 47:744-50; discussion 751. [DOI: 10.1016/j.jvs.2007.11.066] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 11/24/2007] [Accepted: 11/29/2007] [Indexed: 10/22/2022]
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29
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Fabjan TH, Hojs R, Tetičkovič E, Balon BP. Ischaemic stroke - impact of renal dysfunction on in-hospital mortality. Eur J Neurol 2007; 14:1351-6. [DOI: 10.1111/j.1468-1331.2007.01976.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Heider P, Poppert H, Wolf O, Liebig T, Pelisek J, Schuster T, Eckstein HH. Fibrinogen and high-sensitive C-reactive protein as serologic predictors for perioperative cerebral microembolic lesions after carotid endarterectomy. J Vasc Surg 2007; 46:449-54. [PMID: 17826232 DOI: 10.1016/j.jvs.2007.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 05/14/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Neurologic deficit caused by cerebral ischemia defines the outcome of carotid endarterectomy (CEA). Although few patients have clinically evident neurologic deficit, diffusion-weighted imaging (DWI) presents a number of cases with ischemic brain lesions. This study should elucidate preoperative risk factors for perioperative microemboli that cause brain infarction. METHODS We studied 183 patients (58 women, 69.2 +/-12.7 years; 125 men, 69.3 +/- 8.9 years) with high-degree carotid artery stenosis. DWI was performed before and after CEA to analyze new cerebral ischemia. Blood samples were obtained before operation to measure fibrinogen and C-reactive protein (CRP), and preoperative high-sensitive CRP (hsCRP) was analyzed in 30 consecutive patients. RESULTS Postoperative DWI revealed new ipsilateral ischemic lesions in 41 patients (22.4%), and eight (4.4%) showed new neurologic deficit. Preoperative fibrinogen levels were higher in patients with new lesions (397.6 mg/dL +/- 104.7 mg/dL) than in those without (324.7 mg/dL +/- 74.2 mg/dL, P < .001). Preoperative levels of hsCRP were also higher in patients with new lesions (7.9 mg/dL +/- 5.2 mg/dL) than in those without (2.8 mg/dL +/- 2.6 mg/dL, P = .004). Significant association was found between fibrinogen and CRP (Spearman rho = 0.402; P < .001) as well as hsCRP (Spearman rho = 0.603, P = .003). No association was found between postoperative lesions and CRP (P = .833). CONCLUSION The present study demonstrates that preoperative levels of fibrinogen and hsCRP are independent determinants for new periprocedural cerebral ischemic lesions caused by microembolic events. There is still not sufficient evidence to recommend measurement of CRP as a prognostic marker for perioperative cerebral lesion.
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Affiliation(s)
- Peter Heider
- Department of Vascular Surgery, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany.
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31
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Lorenz MW, Karbstein P, Markus HS, Sitzer M. High-Sensitivity C-Reactive Protein Is Not Associated With Carotid Intima-Media Progression. Stroke 2007; 38:1774-9. [PMID: 17446427 DOI: 10.1161/strokeaha.106.476135] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background and Purpose—
It is unclear whether elevated serum C-reactive protein (CRP) is causal to the initiation and progression of atherosclerosis. We undertook a prospective longitudinal cohort study to address this question.
Methods—
In a population-based sample of 3122 subjects, we measured carotid intima media thickness (IMT) at baseline and after 3 years and surveyed clinical events. Associations between baseline high-sensitivity CRP (hs-CRP) and baseline IMT, and IMT progression were determined before and after controlling for vascular risk factors. The relationship between baseline IMT and clinical events during follow up was determined.
Results—
All vascular risk factors were significantly associated with hs-CRP (
P
<0.001). Hs-CRP was significantly associated with baseline IMT in all carotid segments (
P
<0.001), but this association was no longer significant after controlling for age, gender, and cardiovascular risk factors. Hs-CRP was not related to individual IMT progression. Interactions between hs-CRP and body mass index, HbA1c, or blood pressure showed no association with IMT progression. Baseline hs-CRP was related to the risk of clinical events (myocardial infarction or stroke or death, hazard ratio of 1.22 per mg/L hs-CRP increase, 95% CI: 1.07 to 1.39,
P
=0.004, adjusted for age and gender), but this association was not significant after controlling for age, gender, and cardiovascular risk factors (1.59, 95% CI: 0.96 to 2.64,
P
=0.072).
Conclusions—
Our results suggest that hs-CRP is not an independent causal factor for the initiation and progression of early atherosclerotic changes of the carotid arteries. Univariate associations between hs-CRP and IMT were largely explained by confounding by age, gender, and cardiovascular risk factors.
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Affiliation(s)
- Matthias W Lorenz
- Department of Neurology, J.W. Goethe-University, Frankfurt am Main, Germany.
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32
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Broeckel U, Hengstenberg C, Mayer B, Maresso K, Gaudet D, Seda O, Tremblay J, Holmer S, Erdmann J, Glöckner C, Harrison M, Martin LJ, Williams JT, Schmitz G, Riegger GAJ, Jacob HJ, Hamet P, Schunkert H. A locus on chromosome 10 influences C-reactive protein levels in two independent populations. Hum Genet 2007; 122:95-102. [PMID: 17530289 DOI: 10.1007/s00439-007-0380-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 05/09/2007] [Indexed: 01/08/2023]
Abstract
High sensitivity C-reactive protein (hsCRP) is an independent risk factor for cardiovascular disease, such as stroke or coronary artery disease. Genetic factors influence significantly the inter-individual variability of hsCRP. The aim of this study was to identify genomic regions influencing hsCRP levels. A genome scan was performed in two independent studies of Caucasian populations, namely 513 Western-European families ascertained for myocardial infarction (n = 1,406) and 120 French-Canadian families diagnosed with hypertension (n = 758). In the myocardial infarction families, 31% of the inter-individual variation of hsCRP levels was explained by genetic factors (P = 0.0000015) and loci influencing hsCRP were identified on chromosomes 10 (at 141 cM) and 5 (at 150 cM) with multipoint LOD scores of 3.15 and 2.23, respectively. An additional suggestive signal was detected on chromosome 2 in subset analyses. A similar degree of heritability has been observed in a second independent population of French-Canadian hypertensive families for hsCRP (30%) and linkage results for chromosome 10 were confirmed with maximum LOD score of 2.7. We identified a chromosomal region in two independent populations which influences hsCRP in addition to several unique regions. This provides targets for the identification of genes involved in the regulation of hsCRP and the development and progression of vascular disease, including stroke.
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Affiliation(s)
- Ulrich Broeckel
- Department of Medicine, Medical College of Wisconsin, Milwaukee 53226, USA.
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