Role of C-reactive protein in cardiovascular disease

Advancements in electrochemical immunosensors towards point-of-care detection of cardiac biomarkers

Cardiovascular disease remains the leading cause of death worldwide, with mortality rates increasing annually. This underscores the urgent need for accurate diagnostic and monitoring tools. Electrochemical detection has emerged as a promising method for swiftly and precisely measuring specific biomarkers in bodily fluids. This approach is not only cost-effective and efficient compared to traditional clinical methods, but it can also be tailored to detect individual biomarkers, which makes it particularly well-suited for point-of-care (POC) applications. The ability to conduct testing at the point of care is crucial for timely interventions and personalized disease management, empowering healthcare providers to tailor treatment plans based on real-time biomarker data. Thanks to recent advancements in nanomaterials, we've seen significant progress in electrochemical detection, leading to the development of specialized rapid immunoassay systems. These systems utilize specific antibodies to target molecules, expanding the range of detectable biomarkers. This innovation has the potential to revolutionize the diagnosis and treatment of cardiovascular diseases by enhancing detection sensitivity and specificity. Ultimately, these advancements aim to improve patient outcomes by enabling earlier diagnosis, more precise monitoring, and personalized therapeutic interventions, which will contribute to more effective management of cardiovascular health globally.

Relationship Between High Sensitivity C-reactive Protein to Albumin Ratio With Infarct-related Artery Patency in Patients With Non-ST-segment Elevation Myocardial Infarction

The C-reactive protein/albumin ratio (CAR) has recently emerged as a marker for poor prognosis or mortality in various patient groups. This study aimed to examine the relationship between serum CAR and infarct-related artery (IRA) patency in 700 consecutive non-ST-segment elevation myocardial infarction (NSTEMI) patients prior to percutaneous coronary intervention. The study population was separated into 2 different groups according to preprocedural IRA patency as assessed by the degree of Thrombolysis in Myocardial Infarction (TIMI) flow. As a result, occluded IRA was defined as TIMI grade 0-1, while patent IRA was defined as TIMI grade 2-3. High CAR (Odds Ratio: 3.153 (1.249-8.022); P < .001) was found to be an independent predictor of occluded IRA. Additionally, CAR was positively correlated with the SYNTAX score, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio; CAR was negatively correlated with left ventricular ejection fraction. The highest cut-off value of CAR predicting occluded IRA was found to be .18 with 68.3% sensitivity and 67.9% specificity. The area under the curve for CAR was .744 (95% CI: .706-.781) after the receiver-operating characteristic curve assessment.

Biomarkers and optical based biosensors in cardiac disease detection: early and accurate diagnosis

Rapid and precise detection methods for the early-stage detection of cardiovascular irregularities are crucial to stopping and reducing their development. Cardiovascular diseases (CVDs) are the leading cause of death in the world. Hence, cardiac-related biomarkers are essential for monitoring and managing of process. The necessity for biomarker detection has significantly widened the field of biosensor development. Bio-sensing methods offer rapid detection, low cost, sensitivity, portability, and selectivity in the development of devices for biomarker detection. For the prediction of cardiovascular diseases, some biomarkers can be used, like C-reactive protein (CRP), troponin I or T, creatine kinase (CK-MB), B-type natriuretic peptide (BNP), myoglobin (Mb), suppression of tumorigenicity 2 protein (ST2) and galectin-3 (Gal3). In this review, recent research studies were covered for gaining insight into utilizing optical-based biosensors, including surface plasmon resonance (SPR), photonic crystals (PCs), fluorescence-based techniques, fiber optics, and also Raman spectroscopy biosensors for the ultrasensitive detection of cardiac biomarkers. The main goal of this review is to focus on the improvement of optical biosensors in the future for the diagnosis of heart diseases and to discuss how to enhance their properties for use in medicine. Some main data from each study reviewed are emphasized, including the CVD biomarkers and the response range of the optical-based devices and biosensors.

Comparison of Anemia Screening Methods Using Paired Venous Samples in Women of Reproductive Age in Southern India

BACKGROUND

Anemia is an important public health problem, and accurate estimates may inform policy and programs. Although hemoglobin (Hb) assessment of venous blood via automated hematology analyzers (AHAs) is recommended, most population-based surveys estimate anemia prevalence based on analysis of capillary blood via portable hemoglobinometers.

OBJECTIVES

We aimed to evaluate screening methods for hemoglobin and anemia assessment using paired venous samples.

METHODS

Participants were women 15-40 y who were not pregnant or lactating. Paired venous whole blood samples (n = 896) were analyzed for hemoglobin (Hb) via portable hemoglobinometer (HemoCue 301) and Coulter Counter AHA. Anemia and severe anemia were defined as Hb <12.0g/dL and <8.0 g/dL, respectively. Bland-Altman methods were used to assess the level of agreement for Hb results (mean difference, SD of differences, limits of agreement). Diagnostic accuracy parameters (sensitivity, specificity, positive predictive value, negative predictive value, accuracy) were calculated to evaluate HemoCue performance compared to the AHA reference, overall and by sociodemographic, nutritional, and metabolic characteristics.

RESULTS

The estimated anemia prevalence was significantly lower via HemoCue vs. AHA (36.3% compared with 41.6%; P value < 0.0001). The HemoCue had 84.4% accuracy for anemia screening and 98.8% for severe anemia, compared to the AHA reference. The HemoCue had 74.8% sensitivity and 91.2% specificity, compared to AHA. HemoCue sensitivity was higher in women with iron deficiency [serum ferritin (SF) <15.0 μg/L: 81.6% compared with SF ≥15.0 μg/L: 41.3%], and lower in women with metabolic risk factors, including overweight [BMI ≥25.0 kg/m2: 63.9% vs. BMI <25.0 kg/m2: 78.8%], or elevated CRP (>1.0 mg/L: 67.2% vs. ≤1.0 mg/L: 82.9%), trunk fat (>35%: 62.7% vs. ≤35%: 80.1%), or whole-body fat (>35%: 63.9% vs. ≤35%: 80.3%).

CONCLUSIONS

Findings suggest that women with anemia may be incorrectly identified as not anemic via portable hemoglobinometer, and anemia prevalence may be underestimated at the population level.This study was registered at clinicaltrials.gov as NCT04048330.

Consumption of the cell-free or heat-treated fractions of a pitched kefir confers some but not all positive impacts of the corresponding whole kefir

Introduction

Kefir consumption can have many metabolic health benefits, including, in the case of specific kefirs, improvements in plasma and liver lipid profiles. Our group has previously shown that these health benefits are dependent on the microbial composition of the kefir fermentation, and that a pitched kefir (PK1) containing specific traditional microbes can recapitulate the health benefits of a traditional kefir. In this study we investigated how different preparations of kefir impact cholesterol and lipid metabolism and circulating markers of cardiovascular disease risk and determine if freeze-drying impacts health benefits relative to past studies.

Materials and methods

Eight-week-old male and female C57Bl/6 mice were fed a high fat diet (40% kcal from fat) supplemented with one of 3 freeze-dried kefir preparations (whole kefir, cell-free kefir, or heat-treated kefir) for 8 weeks prior to analysis of plasma and liver lipid profiles, circulating cardiovascular disease (CVD) biomarkers, cecal microbiome composition, and cecal short-chain fatty acid levels. These groups of mice were compared to others that were fed a control low-fat diet, control high fat diet or high fat diet supplemented with milk, respectively.

Results

All kefir preparations lowered plasma cholesterol in both male and female mice, while only whole kefir lowered liver cholesterol and triglycerides. Plasma vascular cell adhesion molecule 1 (VCAM-1) was lowered by both whole kefir and heat-treated kefir in male mice but not females, while c-reactive protein (CRP) was unchanged across all high fat diet fed groups in males and females.

Conclusion

These results indicate that some of the metabolic benefits of consumption of this kefir do not require whole kefir while also indicating that there are multiple compounds or components responsible for the different benefits observed.

A Physiological Approach to Inflammatory Markers in Obesity

Obesity is one of the most critical health problems all over the world; it is associated with metabolic dysfunction and overnutrition. Changes in the physiological function of adipose tissue, leading to altered secretion of adipocytokines, inflammatory mediators release, and chronic low-grade inflammation, are seen in obesity. Macrophages, neutrophils, CD4+ and CD8+ T cells, B cells, natural killer T (NKT) cells, eosinophils, mast cells, and adipocytes are involved in the inflammatory response that occurs during obesity. Various inflammatory markers are released from these cells. In this chapter, we will mention inflammatory mechanisms and markers of obesity.

Impact of Systemic Inflammatory Response Syndrome on Clinical, Echocardiographic, and Computed Tomographic Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation

Background

Systemic inflammatory response syndrome (SIRS) is a systemic insult that has been described with many interventional cardiac procedures. The outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) are thought to be influenced by this syndrome not only on short-term, but also on long-term.

Objective

We assessed the association of SIRS to different clinical, echocardiographic, and computed tomographic (CT) outcomes after TAVI.

Methods

Two hundred and twenty-four consecutive patients undergoing TAVI were enrolled in this study. They were assessed for the occurrence of SIRS within the first 48 h after TAVI. Patients were followed-up for short- and long-term clinical outcomes. Serial echocardiographic follow-ups were conducted at 1-week, 6-months, and 1-year. CT follow-up at 1 year was recorded.

Results

Eighty patients (36%) developed SIRS. Among different parameters, only pre-TAVI total leucocytic count (TLC), pre-TAVI heart rate, and post-TAVI systolic blood pressure independently predicted the occurrence of SIRS. The incidence of HALT was not significantly different between both groups, albeit higher among SIRS patients (p = 0.1) at 1-year CT follow-up. Both groups had similar patterns of LV recovery on serial echocardiography. Long-term follow-up showed that all-cause death, cardiac death, and re-admission for heart failure (HF) or acute coronary syndrome (ACS) were significantly more frequent among SIRS patients. Early safety and clinical efficacy outcomes were more frequently encountered in the SIRS group, while device-related events and time-related valve safety were comparable.

Conclusion

Although SIRS implies an early acute inflammatory status post-TAVI, yet its clinical sequelae seem to extend to long-term clinical outcomes.

Relationship Between Plasma Olanzapine and N-Desmethyl-Olanzapine Concentration and Metabolic Parameters in Patients With Schizophrenia

OBJECTIVES

The aim of the present study was to investigate a potential relationship between metabolic parameters and steady-state plasma concentrations of olanzapine (OLA) and its metabolite, 4-N'-desmethyl-olanzapine (DMO) in patients with schizophrenia taking therapeutic doses.

METHODS

A total of 352 inpatients, diagnosed with schizophrenia according to the DSM-V criteria and treated with OLA, were investigated. The plasma concentrations of OLA and DMO were measured by high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS). Fasting blood samples were measured for insulin, glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), C-reactive protein (CRP) and homocysteine, and differences in these parameters were investigated in relation to plasma concentrations of OLA and DMO.

RESULTS

Lower plasma DMO concentrations were associated with higher glucose and TG levels and homeostasis model assessment of insulin resistance (HOMA-IR), while higher plasma OLA concentrations were associated with higher CRP and homocysteine levels in the OLA-treated patients with schizophrenia.

CONCLUSION

These results demonstrate that OLA and its metabolite DMO may have different effects on OLA-induced metabolic abnormalities. DMO might have a counteracting effects on glucose-insulin homeostasis and lipid metabolic abnormalities, which suggests that regular measure of various metabolic parameters and drug monitoring on both OLA and DMO are recommended in OLA-treated patients with schizophrenia.

PEX-168 improves insulin resistance, inflammatory response and adipokines in simple obese mice: a mechanistic exploration

BACKGROUND

Polyethylene glycol loxenatide (PEX-168) is a new antidiabetic drug; as such, there are not yet any reports on its weight loss effect. Therefore, this trial was designed to investigate the effect of PEX-168 on simple obese mice.

METHODS

Thirty healthy male C57BL/6 mice were randomly selected and divided into a control group (NC) and an obesity model group. The high-fat diet-induced simple obesity mice were divided into a model control group (HF) and three intervention groups. The intervention groups were injected with different doses of PEX-168 intraperitoneally once a week for 12 weeks (low (LD), medium (MD) and high (HD)). Fasting blood glucose (FBG), body weight and food intake were measured from 1 to 12 weeks after PEX-168 injection. The serum insulin (INS), C-reactive protein (CRP), chemerin and omentin levels were measured after 12 weeks.

RESULTS

Compared with the HF group, the low dose of PEX-168 reduced the body weight of the mice in a short period of time (8 weeks), and the mice in the MD and HD groups showed a significant decrease in body weight (P < 0.05). The low dose of PEX-168 could effectively improve the blood glucose and homeostasis model assessment of insulin resistance (Homa-IR) of the mice (FBG P < 0.05 INS, Homa-IR P < 0.001), but there was no significant difference between different doses (P > 0.05). CRP levels in the MD and HD groups were significantly improved (P < 0.05). The levels of serum chemerin and omentin in the intervention groups were also significantly improved (P < 0.01), but there was no significant difference between the different doses (P > 0.05).

CONCLUSIONS

PEX-168 significantly reduced the body weight of simple obese mice and improved the insulin resistance. PEX-168 may regulate the expression of chemerin and omentin through its hypoglycaemic effect, and the weight-reducing effect of PEX-168 is unlikely to be the reason for the changes in both.

Determination of risk factors associated with inflammation in hypertensive patients with type-2 diabetes mellitus in a Palestinian Diabetes Study

OBJECTIVE

To determine the risk factors associated with inflammation in hypertensive patients with type-2 diabetes mellitus.

METHODS

A total of 164 hypertensive patients with type 2 diabetes patients aged 38-60 years were selected from 7 primary healthcare centers in Gaza city, Palestine. Interview questionnaire were employed to collect data related to age, gender, smoking habits, and physical activity pattern. Laboratory biochemical tests included fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), interleukin 6 (IL-6), high sensitive C reactive protein (hs-CRP), and adiponectin were estimated in all patients.

RESULTS

The study involved 118 (72%) women and 46 (28%) men; the mean of age was 53.7 ± 0.46 years. A tertile of inflammation feature with hs-CRP was developed. The highest tertile of hs-CRP was significantly associated with women, higher obesity indices, metabolic dysregulation involving lipid profile markers, FBG and blood pressure, IL-6, and lower adiponectin. After adjusting for age, gender, smoking habits, and physical activity; the risk factor of high level of hs-CRP were the increased body mass index [OR: 1.17, p = .018], IL-6 [OR: 2.22, p = .025] and FBG [OR: 1.01, p = .007], as well as reduced adiponectin [OR: 0.81, p = .002].

CONCLUSION

The inflammation state was affected by obesity and had been related to altered adipokines levels of IL-6 and adiponectin, as well as affected by the glycemic control, as evidenced by higher serum level of FBG.

Effects of garlic supplementation on serum inflammatory markers: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

Previous studies have indicated that garlic consumption may be beneficial in improving inflammation. This systematic review and meta-analysis aimed to examine the effect of garlic supplementation on inflammatory biomarkers.

METHODS

PubMed/Medline, Scopus and ISI web of science were searched up to February 2019. Random effects model was used to calculate the overall effects on C-reactive protein (CRP), Interleukin-6 (IL-6), and Tumor necrosis factor- α (TNF-α).

RESULTS

17 randomized controlled trials (RCTs) were included in the meta-analyses. Garlic supplementation significantly reduced the level of circulating CRP (P < 0.05), whereas it did not have any significant effect on IL-6 level (p > 0.05). Sub-group analysis showed that aged garlic extract (AGE) was able to reduce CRP and TNF-α significantly (P < 0.05).

CONCLUSIONS

This meta-analysis showed that supplementation with garlic could reduce the level of circulating CRP and AGE could reduce the level of TNF-α and CRP, whereas it had no significant effect on the IL-6 level.

Association of serum FGF-23, klotho, fetuin-A, osteopontin, osteoprotegerin and hs-CRP levels with coronary artery disease

Environmental, genetic, oxidative and biochemical factors play an important role in the atherosclerotic process. We investigated the association of serum fibroblast growth factor (FGF-23), klotho, fetuin-A, osteoprotegerin (OPG), osteopontin (OPN) and high-sensitive-CRP (Hs-CRP) markers with coronary artery disease and whether one was superior to others or not. A study group of 52 patients with coronary artery disease (CAD) and a control group of 30 patients with angiographically normal epicardial coronary arteries were included in the study. Serum FGF-23, klotho, fetuin-A, OPN, OPG and Hs-CRP marker levels were studied. Patients with CAD were classified in two groups as low (SYNTAX ≤22, n = 29) and moderate-high (SYNTAX ≥ 23, n = 23) according to anatomic SYNTAX score. FGF-23 (p = .033), klotho (p < .001), fetuin-A (p = .005) and OPG (p = .001) serum marker levels were significantly lower in CAD patients than the control group. Serum levels of FGF-23 (p = .012), klotho (p = .001), fetuin-A (p = .015) and OPG (p = 0.002) were significantly different between SYNTAX tertiles and control group. Klotho (p = .025, odd ratio (OR) = 0.542, 95% confidence interval (CI): 0.317-0.926) and HT (p = .004, OR = 34.598, 95%CI:1.054-1135.657) were the independent predictors of CAD presence. Serum klotho levels of 91.48 pmol/L predicts the presence of CAD with 60% sensitivity and 96.55% specificity (p < .001, area under curve = 0.864, 95% CI = 0.768, 0.931). We found that serum klotho level is an independent predictor of presence, extent and severity of CAD.

Obesity and inflammation: the linking mechanism and the complications

Obesity is the accumulation of abnormal or excessive fat that may interfere with the maintenance of an optimal state of health. The excess of macronutrients in the adipose tissues stimulates them to release inflammatory mediators such as tumor necrosis factor α and interleukin 6, and reduces production of adiponectin, predisposing to a pro-inflammatory state and oxidative stress. The increased level of interleukin 6 stimulates the liver to synthesize and secrete C-reactive protein. As a risk factor, inflammation is an imbedded mechanism of developed cardiovascular diseases including coagulation, atherosclerosis, metabolic syndrome, insulin resistance, and diabetes mellitus. It is also associated with development of non-cardiovascular diseases such as psoriasis, depression, cancer, and renal diseases. On the other hand, a reduced level of adiponectin, a significant predictor of cardiovascular mortality, is associated with impaired fasting glucose, leading to type-2 diabetes development, metabolic abnormalities, coronary artery calcification, and stroke. Finally, managing obesity can help reduce the risks of cardiovascular diseases and poor outcome via inhibiting inflammatory mechanisms.

The relationship between serum levels of hs-CRP and coronary lesion severity

Background and aim

It is very important to know the risk factors of coronary artery disease and the role of inflammatory markers. One of these markers is hs-CRP that has been indicated to increase in patients with coronary artery atherosclerosis. The main objective of this study was to determine the relationship between serum levels of hs-CRP and coronary lesion severity.

Methods

In the current study, we evaluated the role of hs-CRP in coronary artery disease and measured the relationship between serum hs-CRP levels and the severity of coronary lesions in 102 patients who referred to Imam Khomeini Hospital, Iran. The number of involved coronary arteries was measured. The severity of coronary lesions was evaluated by Gensini scoring method and the association between severity of coronary artery lesions and serum hs-CRP levels and other risk factors were examined.

Results

No significant difference was found between the two groups in terms of gender. Severity of lesions had no significant difference according to Gensini score in women compared with men. Mean Gensini score was significant between the two groups (66.79±48.12 in hs-CRP positive group versus 21.09±26.25 in negative ones, p<0.05). In addition, diabetic patients were significantly more in hs-CRP positive group than negative hs-CRP group (P<0.05). In terms of smoking, there was a significant difference between the two groups. Percentage of patients with hypercholesterolemia was significantly higher in hs-CRP negative group. There was a significant difference in severity of lesions between smokers and non-smokers.

Conclusion

No significant correlation was observed between serum levels of hs-CRP and severity and angiographic extent on coronary arteries in our study. Considering the potential risk of coronary inflammatory process as a new variable, it can help discover new cases of coronary lesions and follow-up and control of the selected cases.

Cardioprotective effects of rutin via alteration in TNF-α, CRP, and BNP levels coupled with antioxidant effect in STZ-induced diabetic rats

Diabetic cardiomyopathy (DCM) is a dreadful complication of diabetes responsible for 80 % mortality in diabetic patients, but unfortunately its pharmacotherapy is still incomplete. Rutin is a naturally occurring flavonoid having a long history of use in nutritional supplements for its action against oxidative stress, inflammation, and hyperglycemia, the key players involved in the progression of DCM, but remains unexplored for its role in DCM. This study was conducted to address this lacuna. It was performed in 4-week-old Streptozotocin-induced (45 mg/kg) diabetic rats for a period of 24 weeks to mimic the cardiotoxic effect of chronic hyperglycemia in diabetic patient's heart and to investigate the effect of rutin (50 mg/kg/day) in ameliorating these effects. Heart of the diabetic rats showed altered ECG parameters, reduced total antioxidant capacity, increased inflammatory assault, and degenerative changes. Interestingly, rutin treatment significantly ameliorated these changes with decrease in blood glucose level (p > 0.001), % HbA1c (p > 0.001) and reduced expression of TNF-α (p < 0.001), CRP (p < 0.001), and BNP (p < 0.01) compared to diabetic control rats. In addition, rutin provided significant protection against diabetes associated oxidative stress (p < 0.05), prevented degenerative changes in heart, and improved ECG parameters compared to diabetic control rats. The heart-to-body weight ratio was significantly reduced in rutin treatment group compared to diabetic control rats (p < 0.001). In conclusion, this study implicates that oxidative stress and inflammation are the central players involved in the progression of DCM and rutin ameliorates DCM through its antioxidant and anti-inflammatory actions on heart.

Obesity can predict and promote systemic inflammation in healthy adults

BACKGROUND

To find out the differences on biomedical data between obese and non-obese participants, and to identify risk factors associated with systemic inflammation in healthy Palestinian adults.

METHODOLOGY

A cross-sectional study involved 105 apparently healthy adults. Interview questionnaire was used to collect personal information. Participants were excluded if they suffered from acute or chronic inflammatory diseases, or continued using medicines, which might affect the biomedical results.

RESULTS

In association with increased Body Mass Index (BMI), the obese group displayed significant higher markers including: interleukin 6 (IL-6), high sensitivity C reactive protein (hs-CRP), total cholesterol (TC), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Obese group in association with increased waist circumference (WC) was higher significantly in inflammatory markers (IL-6, hs-CRP), lipid profile (TC) and triglyceride (TG), and blood pressure (SBP, DBP). A tertile of a feature of systemic inflammation (hs-CRP) was created, by Ordinal Logistic Regression, after adjusting for the age, gender, smoking habits, physical activity pattern, father and mother's health history; risk factors were the increased BMI [OR: 1.24] (95% CI: 1.005-1.548, P=0.050), IL-6 [OR: 3.35] (95% CI: 1.341-8.398, P=0.010), DBP [OR: 1.19] (95% CI: 1.034-1.367, P=0.015), and reduced Adiponectin [OR: 0.59] (95% CI: 0.435-0.820, P=0.001). Finally, BMI correlated with IL-6 and hs-CRP (r=0.326, P=0.005; r=0.347, P<0.001; respectively), and hs-CRP correlated with IL-6 (r=0.303, P=0.010), and inversely with Adiponectin (r=-0.342, P=0.001).

CONCLUSION

The increased level of IL-6 and reduced Adiponectin, which strongly associated with obesity, indicated that having high BMI is a useful marker in association with IL-6 and further developed systemic inflammation.

Two Valid Measures of Self-rated Physical Activity and Capacity

Objectives:

Questionnaires on physical activity (PA) and physical capacity (PC) are valuable tools, as they are cost beneficial, and have high response rates. The validity of short versions of such questionnaires has not been examined satisfactorily. Therefore, we aimed at examining the validity of a set of questions coding for PA and PC.

Design:

The questions were administered to 217 men and women attending a cardiac rehabilitation program. Participants also gave blood samples, measuring HDL cholesterol, triglycerides (TG), insulin, glucose, and microCRP. The relations between PA and PC and biological markers were examined by linear regression analyses.

Results:

Measures for PC and for PA were identified by factor analysis, which proved internally consistent. TG, homeostatic model assessment (HOMA) score, and mCRP were all significantly associated with the measures of PC and PA.

Conclusions:

The measures of PA and PC are valid compared with biological markers, allowing cost-beneficial and time-efficient evaluation of important measures for cardiovascular health.

Effects of ozone and fine particulate matter (PM(2.5)) on rat system inflammation and cardiac function

In order to understand the toxic mechanisms of cardiovascular system injuries induced by ambient PM(2.5) and/or ozone, a subacute toxicological animal experiment was designed with exposure twice a week for 3 continuous weeks. Wistar rats were randomly categorized into 8 groups (n=6): 1 control group, 3 groups exposed to fine particulate matters (PM(2.5)) alone at 3 doses (0.2, 0.8, or 3.2 mg/rat), 1 group to ozone (0.81 ppm) alone and 3 groups to ozone plus PM(2.5) at 3 doses (0.2, 0.8, or 3.2 mg/rat). Heart rate (HR) and electrocardiogram (ECG) was monitored at approximately 24-h both after the 3rd exposure and the last (6th) exposure, and systolic blood pressure (SBP) was monitored at approximately 24-h after the 6th exposure. Biomarkers of systemic inflammation and injuries (CRP, IL-6, LDH, CK), heart oxidative stress (MDA, SOD) and endothelial function (ET-1, VEGF) were analyzed after the 6th exposure. Additionally, myocardial ultrastructural alterations were observed under transmission electron microscopy (TEM) for histopathological analyses. Results showed that PM(2.5) alone exposure could trigger the significant increase of CRP, MDA, CK, ET-1 and SBP and decrease of heart rate variability (HRV), a marker of cardiac autonomic nervous system (ANS) function. Ozone alone exposure in rats did not show significant alterations in any indicators. Ozone plus PM(2.5) exposure, however, induced CRP, IL-6, CK, LDH and MDA increase, SOD and HRV decrease significantly in a dose-response way. Meanwhile, abnormal ECG types were monitored in rats exposed to PM(2.5) with and without ozone and obvious myocardial ultrastructural changes were observed by TEM. In conclusion, PM(2.5) alone exposure could cause inflammation, endothelial function and ANS injuries, and ozone potentiated these effects induced by PM(2.5).

The high-dose rosuvastatin once weekly study (the HD-ROWS)

BACKGROUND

Alternative dosing is often used clinically to address common barriers with statin therapy, such as intolerance and cost. Previous findings have demonstrated significant and clinically similar reductions in low-density lipoprotein (LDL) cholesterol to daily dosing, when comparing similar total weekly doses.

OBJECTIVE

To determine whether rosuvastatin 80 mg once weekly produced comparable lipid and high-sensitivity C-reactive protein (hsCRP) changes to atorvastatin 10 mg daily, when measured at key points after last dose.

METHODS

This was a randomized, double-blind, parallel group, 8-week pilot study. Eligible subjects, 18 to 65 years of age, had documented dyslipidemia with LDL cholesterol >100 mg/dL and triglycerides <200 mg/dL. Participants were randomized to receive either rosuvastatin 80 mg once weekly (n = 10) or atorvastatin 10 mg daily (n = 10), for 8 weeks. Lipid panels and hsCRP were measured at baseline and 1-4 and 5-8 days after the last dose.

RESULTS

Participants in each arm experienced significant and comparable reductions from baseline in total cholesterol, total cholesterol/high-density lipoprotein cholesterol ratio, non-high-density lipoprotein cholesterol, and overall LDL cholesterol (-29%). Changes in high-density lipoprotein cholesterol, triglycerides, and hsCRP were nonsignificant and similar between groups. Each regimen was well tolerated, with no major adverse events reported.

CONCLUSION

Rosuvastatin 80 mg once weekly produced comparable lipid changes to atorvastatin 10 mg daily when measured at specific points after the last dose. Our findings support previous data demonstrating a significant reduction in LDL-C with once weekly statin dosing.

Body Mass Index Misclassification of Obesity among Community Police Officers

Occupational health nurses are at the forefront of obesity assessment and intervention and must be aware of potential inaccuracies of obesity measurement. The purpose of this study was to identify the prevalence of obesity among a sample of 84 male police officers 22 to 63 years old and determine the accuracy of body mass index (BMI) in estimating obesity compared to body fat percent (BF %). BMI identified 39.3% of the participants as obese, compared to 70.2% by BF %. BMI misclassified normal-weight officers as obese or overweight and obese officers as normal 48.8% ( n = 41) of the time. The two misclassified groups had similar average BMIs but significantly different BF %. BMI was not an accurate measure of obesity among adult males. BMI underestimated the true prevalence of obesity and could represent a missed opportunity for early intervention and disease prevention.

Body mass index misclassification of obesity among community police officers

Occupational health nurses are at the forefront of obesity assessment and intervention and must be aware of potential inaccuracies of obesity measurement. The purpose of this study was to identify the prevalence of obesity among a sample of 84 male police officers 22 to 63 years old and determine the accuracy of body mass index (BMI) in estimating obesity compared to body fat percent (BF %). BMI identified 39.3% of the participants as obese, compared to 70.2% by BF %. BMI misclassified normal-weight officers as obese or overweight and obese officers as normal 48.8% (n = 41) of the time. The two misclassified groups had similar average BMIs but significantly different BF %. BMI was not an accurate measure of obesity among adult males. BMI underestimated the true prevalence of obesity and could represent a missed opportunity for early intervention and disease prevention.

New evidence for nicotinic acid treatment to reduce atherosclerosis

Nicotinic acid (at a daily dose of grams) has been shown to induce potent anti-atherosclerotic effects in human and animal models. Evidence from clinical studies performed in the 1950s has shown that nicotinic acid treatment remarkably improves the plasma lipid profile. Large clinical studies showed that nicotinic acid improves clinical cardiovascular outcomes. Given the protective effects of niacin, basic research studies were designed to explore additional anti-atherosclerotic pathways, such as those involved in cardiovascular inflammation. After the discovery of the nicotinic acid receptor GPR109A on adipocytes and immune cells, novel direct immunomodulatory properties of nicotinic acid have been identified. Importantly, the regulation of the release of inflammatory mediators from adipose tissue was observed, independent of lipid level amelioration. Less is known about the possible direct anti-inflammatory activities of nicotinic acid in other cells (such as hepatocytes, endothelial and vascular cells) previously indicated as key players in atherogenesis. Thus, further studies are needed to clarify this promising topic. Emerging evidence from clinical and basic research studies indicates that novel direct anti-atherosclerotic properties might mediate nicotinic acid-induced cardiovascular protection. Despite some limitations in its clinical use (mainly due to the incidence of adverse events, such as cutaneous flushing and hepatotoxicity), nicotinic acid should be considered as a very potent therapeutic approach to reduce atherosclerosis. Promising research developments are warranted in the near future.

The effect of aspirin on C-reactive protein in hypertensive patients

High level of C-reactive protein (CRP), most popular inflammatory marker, increases the risk of thrombotic cardiovascular events. Aspirin, which has both anti-inflammatory and anti-thrombotic effects, has the potential to influence CRP release. Several studies have been reported investigating clinical effects of aspirin on CRP levels. Some studies have reported aspirin reduced CRP levels, but other studies did not. This study was designed to assess the effect of low-dose aspirin on CRP levels in controlled hypertensive patients who had low inflammatory burden. Two hundred twenty-five patients with controlled hypertension were randomly divided into two groups; aspirin group (n = 122, 100 mg of aspirin) and the control group (n = 134). Patients with a CRP level >1 mg/dL (10 mg/L) were excluded because these high levels suggest infection. C-reactive protein level and lipid profiles were measured before therapy and 3 months after therapy. There were no differences in baseline clinical characteristics between the two groups. Low-dose aspirin showed no significant influence on CRP levels over 3 months (from 0.10 ± 0.0099 to 0.12 ± 0.0097 mg/dL, p = 0.12). Statin therapy did not influence CRP levels. Aspirin-resistance also had no influence on CRP levels. We conclude that low-dose aspirin has no significant effect on decreasing CRP levels in the patients with controlled hypertension which had low inflammatory burden. The anti-inflammatory mechanism may not play an important role in the cardioprotective effect of aspirin in the population with low inflammatory burden such as controlled hypertensive patients.

Possible effects of some antipsychotic drugs on C-reactive protein in a drug-naïve psychotic sample

Antipsychotic effects on C-reactive protein (CRP) have received little attention. This randomized open-label study investigated the possible effects of antipsychotics on CRP levels after 3 and 12 months of treatment in a Spanish drug-naïve sample taking haloperidol (N=36 after 3 months), olanzapine (N=36 after 3 months) or risperidone (N=39 after 3 months). After 3 months and adjusting for differences in baseline CRP levels, baseline smoking and high baseline triglyceride levels, patients on haloperidol treatment had CRP levels that were 92.7% higher than those of patients on risperidone treatment (p=0.009). After 12 months, only smoking was associated with increased CRP levels. Future studies need to verify that different antipsychotics may have differential effects on CRP levels, particularly after 3 months of treatment.

High-sensitivity C-reactive protein and mean platelet volume in paediatric hypertension

The purpose of the study was to investigate serum uric acid (SUA), high-sensitivity C-reactive protein (hs-CRP) and mean platelet volume (MPV) in pre-hypertensive (PH) and hypertensive (HT) children and adolescents. The study group consisted of 80 patients aged 10-19 years subdivided into PH and HT groups according to mean daytime or night-time systolic or diastolic blood pressure (BP) levels (> 90th percentile, but < 95th percentile and > or = 95th percentile, respectively). The control group (C) contained 25 normotensive subjects. Serum hs-CRP level was determined by a nephelometric method (Behring); platelets (PLTs) were counted, and MPV was assessed by a Coulter Analyzer MAXM. SUA was measured with an Hitachi instrument. The median SUA and hs-CRP levels in PH and HT subjects were significantly higher than those of the controls (P < 0.01) and were higher in the HT group than in the PH group (P < 0.05). An increase in SUA above 5.5 mg/dl was associated with an increase in hs-CRP [odds ratio (OR) 4.8; confidence interval (CI) 1.3-17.4; P < 0.01]. MPV values in the PH group did not differ from those of the controls (P > 0.05), but it was significantly higher in HT patients (P < 0.01). Serum hs-CRP and MPV concentrations were positively correlated with all BP measurements except night-time diastolic blood pressure (DBP). We demonstrated that, in HT children and adolescents, increased SUA with a parallel increase in hs-CRP and PLTs with MPV is observed. Although large, multicentre, prospective studies are needed to confirm this observation, hyperuricaemia seems to be associated with an increase in hs-CRP in PH and HT patients.

Prognostic value of high-sensitivity C-reactive protein in heart failure: a systematic review

BACKGROUND

Several studies have suggested that high-sensitivity C-reactive protein (hsCRP) is a strong independent predictor of acute myocardial infarction and cardiovascular death. In the specific heart failure (HF) context, a low-grade inflammatory state can contribute to HF progression.

AIMS

To perform a systematic review on the current knowledge about low-grade inflammation, as assessed by hsCRP, in the prediction of HF in general and in high-risk populations as well as its prognostic value in established HF.

METHODS

We used a computerized literature search in the Medline database using the following key words: C-Reactive Protein, Heart Failure, Cardiomyopathy, Cardiac Failure, Prognosis, and Death. Articles were selected if they had measurements of hsCRP in different patient samples and reference to outcomes in terms of morbidity and mortality.

RESULTS

hsCRP is associated with incident HF in general and high-risk populations and provides prognostic information in HF patients. In almost all studies, the association of hsCRP with clinical events was independent of other baseline variables known to influence morbidity and mortality. Very different cutoffs have been proposed in each context across studies.

CONCLUSIONS

The prognostic power of hsCRP, whether we consider incident HF or adverse outcomes in established HF, is consistent in different patient populations.

New evidences for C-reactive protein (CRP) deposits in the arterial intima as a cardiovascular risk factor

Inflammatory processes are orchestrated by several soluble molecules, which interact with cell populations involved. Cytokines, chemokines, acute-phase reactants, and hormones are crucial in the evolution of several inflammatory disorders, such as atherosclerosis. Several evidences suggest that C-reactive protein (CRP) started to be considered as a cardiovascular risk factor, since CRP directly induces atheroslerosis development. The recent demonstration of CRP production not only by the liver, but also within atherosclerotic plaques by activated vascular cells, also suggests a possible dual role, as both a systemic and tissue agent. Although more studies are needed, some therapeutic approaches to reduce CRP levels have been performed with encouraging results. However, given the strong limitations represented by its low specificity and still accordingly with the American Heart Association, there is no need for high sensitivity CRP screening of the entire adult population as a public-health measure. The measure of serum CRP might be useful only for patients who are considered at intermediate risk.

C-reactive protein levels according to physical activity and body weight for participants in the coronary health improvement project

OBJECTIVES

To identify whether the Coronary Health Improvement Project (CHIP), an intervention designed to increase physical activity and improve diet, lowers serum C-reactive protein (CRP). The study will also assess whether changes in CRP over the study period are associated with baseline levels of and changes in selected coronary risk factors.

METHODS

A randomized controlled study design assigned 348 individuals to the intervention or control group with measurements taken at baseline, 6 weeks, and 6 months of body weight, physical activity, and serum CRP levels. Participants attended an intensive 40-hour educational course delivered over a 4-week period, beginning March 2003, in Rockford, IL, USA.

RESULTS

The intervention significantly increased physical activity and decreased BMI, weight, percent body fat, and saturated fat (P<0.0001). However, the intervention was not significantly associated with a decrease in CRP. Participants in both the intervention and control groups combined showed a decrease in high CRP (>3 mg/L), from 46% at baseline to 38% at 6 weeks and 41% at 6 months. Those with higher BMI at baseline showed a greater increase in CRP over time (P<0.0001), whereas those with higher CRP at baseline showed a greater decrease in CRP over time (P<0.0001).

CONCLUSIONS

Over 6 week and 6 month follow-up periods, the intervention failed to discriminate changes in CRP. However, the percentage with high CRP did fall, more so for those with lower BMI and higher CRP at baseline. BMI may mediate the influence of physical activity on CRP.

Impact of off-pump coronary artery bypass surgery on systemic inflammation: current best available evidence

The systemic inflammatory response after coronary artery bypass grafting using cardiopulmonary bypass (CPB) contributes substantially to postoperative organ dysfunction and coagulation disorders. Important features of this inflammatory reaction include the activation of complement and leukocytes, the release of proinflammatory cytokines, alterations in the metabolism of nitric oxide, and an increase in the production of oxygen-free radicals, which in some cases may lead to oxidant stress injury. Several strategies including the use of steroids, use of aprotinin, heparin-coated CPB circuits, and hemofiltration have been reported to reduce the inflammatory reaction induced by CPB and its consequences. A more radical and effective way of counteracting the effects of the inflammatory reaction and oxidative stress may be the omission of CPB itself. The development and application of off-pump coronary artery bypass (OPCAB) technology has largely been driven by this theme of avoiding systemic inflammatory reaction to decrease the incidence and/or severity of adverse outcomes. This review article discusses the influence of cardiopulmonary bypass on systemic inflammation and attempts to evaluate the current best available evidence on the impact of OPCAB on systemic inflammation.

Association among C-reactive protein, Fatty liver disease, and cardiovascular risk

Nonalcoholic fatty liver disease (NAFLD) is associated with several metabolic disturbances involving inflammation. Ultrasensitive C-reactive protein (uCRP), a marker of coronary heart disease and other chronic diseases, has not been investigated in NAFLD. We tested the relationship between uCRP and NAFLD in middle-aged asymptomatic subjects, independently of other metabolic disturbances associated with metabolic syndrome and cardiovascular risk. We compared 310 subjects with steatosis visible on ultrasound (cases) with 630 and without (controls). Body mass index (BMI), blood pressure and serum levels of uCRP, glucose, lipids, and lipoproteins were measured in all subjects. Differences between groups and the impact of serum uCRP levels were tested by univariate and multivariate logistic regression analysis. Cases were statistically different from controls in the frequency of metabolic syndrome (66.4% vs. 26.7%; P < 0.001). Cases were significantly older (P < 0.001), and had significantly higher values for BMI, glucose, total cholesterol and triglycerides (P < 0.001), and mean uCRP concentrations (4.5 vs. 2.79 mg/L; P < 0.001). By univariate analysis, variables significantly associated with cases were glucose (OR, 4.09; 95% CI, 2.98-5.61), BMI (OR 5.54; 95% CI, 4.09-7.49), and uCRP (OR 7.06; 95% CI, 4.51-11.02). By multivariate analysis, uCRP levels were associated with hepatic steatosis (OR 5.83; 95% CI, 3.07-11.06). Cardiovascular risk was also higher in subjects with NAFLD (4.7 vs. 2.8). Subjects with hepatic steatosis showed an increased concentration of uCRP independently of other metabolic disturbances; this suggests an increased risk of cardiovascular diseases and could be used as a marker of chronic inflammation.

Fibrates: What Have We Learned in the Past 40 Years?

The prominent use of fibric acid derivatives has lessened over the years because of unimpressive results in major clinical trials, safety concerns, and the emergence of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). Clofibrate was widely used in the 1970s, but after publication of results from two major trials demonstrating only modest reductions in the rate of coronary heart disease (CHD) and concerns regarding an increase in the frequency of gallstones and overall mortality, its use subsided dramatically. With the introduction of gemfibrozil in the 1980s came a renewed interest in the class, which was also supported by the published results of the Helsinki Heart Study; however, despite a significant reduction in CHD events and a sound safety profile, overall mortality was comparable to that with placebo. Again, in the 1990s, awareness of the fibrates was heightened with the availability of fenofibrate and the findings of another major trial using gemfibrozil, the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT), which demonstrated impressive results in reducing cardiovascular events. To further strengthen the VA-HIT results, numerous post hoc analyses were performed on the data of major trials of fibrate therapy among patients with mixed dyslipidemia, with similar findings. Recently, however, data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study were published, indicating mixed results. Nearly 40 years after the introduction of the fibrates, practitioners are still contemplating the role of these agents in the treatment of CHD.

Amlodipine Added to Quinapril vs Quinapril Alone for the Treatment of Hypertension in Diabetes: The Amlodipine in Diabetes (ANDI) Trial

This randomized, comparative, parallel-group trial investigated strategies of blood pressure (BP)-lowering in patients with diabetes and hypertension. Patients not reaching goal BP (<130/80 mm Hg) after 4-week open-label treatment with quinapril 20 mg/d (n=374) received 40 mg/d quinapril (n=167) or 20 mg/d quinapril plus amlodipine besylate (5 mg/d; n=162) for 6 weeks. Patients receiving combination therapy vs monotherapy had significantly greater reductions in mean +/- SE sitting systolic BP (9.9+/-1.0 mm Hg vs 4.3+/-1.1 mm Hg; P<.001) and diastolic BP (6.5+/-0.6 mm Hg vs 2.7+/-0.6 mm Hg; P<.001). No significant differences between groups were observed in percentage of patients achieving goal BP (10.1% with combination therapy vs 8.2% with monotherapy). A clinically neutral effect was observed on high-sensitivity C-reactive protein in both groups. Treatments were well tolerated; fewer than 3% of patients in any group discontinued due to treatment-emergent or treatment-related adverse events. In diabetic hypertensive patients, 20 mg/d quinapril plus 5 mg/d amlodipine besylate was a more effective BP-lowering strategy than monotherapy with 40 mg/d quinapril.

The dual role of p55 tumour necrosis factor-alpha receptor in Actinobacillus actinomycetemcomitans-induced experimental periodontitis: host protection and tissue destruction

Inflammatory immune reactions in response to periodontopathogens are thought to protect the host against infection, but may trigger periodontal destruction. Thus, we examined the mechanisms by which the proinflammatory cytokine tumour necrosis factor (TNF)-alpha modulates the outcome of Actinobacillus actinomycetemcomitans-induced periodontal disease in mice. Our results showed that TNF-alpha receptor p55-deficient mice [p55TNF-knock-out (KO)] developed a less severe periodontitis in response to A. actinomycetemcomitans infection, characterized by significantly less alveolar bone loss and inflammatory reaction. Real-time polymerase chain reaction (PCR) demonstrated that levels of chemokines (CXCL1, 3 and 10; CCL3 and 5) and their receptors (CXCR2 and 3, CCR5) were lower in p55TNF-KO mice, as were matrix metalloproteinase (MMP)-1, 2 and 9 and receptor activator of nuclear factor kB ligand (RANKL) mRNA levels. However, the absence of the TNF-alpha p55 results in an impairment of protective immunity to A. actinomycetemcomitans infection, characterized by increased bacterial load and higher levels of C-reactive protein during the course of disease. Such impaired host response may be the result of the reduced chemoattraction of lymphocytes, neutrophils and macrophages, and reduced inducible nitric oxide synthase expression (iNOS) and myeloperoxidase (MPO) production in periodontal tissues of p55 TNF-KO mice. Our results demonstrate the mechanisms involved determining periodontal disease severity by TNF-alpha receptor p55, and its role in providing immune protection to A. actinomycetemcomitans periodontal infection.

C-reactive protein (CRP)-lowering agents

C-reactive protein (CRP) plays a role in the pathogenesis of cardiovascular disease. It is a marker and predictor of cardiovascular disease. CRP possesses numerous cardiovascular effects (clotting, generation of oxygen radicals, increase in the expression of adhesion molecules and plasminogen activator inhibitor-1, plaque destabilization) that could result in cardiovascular disease. This review describes the effects of various cardiovascular drugs on the levels of CRP in health and disease. Cyclooxygenase inhibitors (aspirin, rofecoxib, celecoxib), platelet aggregation inhibitors (clopidogrel, abciximab), lipid lowering agents (statins, ezetimibe, fenofibrate, niacin, diets), beta-adrenoreceptor antagonists and antioxidants (vitamin E), as well as angiotensin converting enzyme (ACE) inhibitors (ramipril, captopril, fosinopril), reduce serum levels of CRP; while enalapril and trandolapril have not been shown to have the same effect. Angiotensin receptor blockers (ARBs) (valsartan, irbesartan, olmesartan, telmisartan) markedly reduce serum levels of CRP. The findings with other ARBs (losartan and candesartan) were inconsistent. Antidiabetic agents (rosiglitazone and pioglitazone) reduce CRP levels, while insulin is ineffective. Calcium channel antagonists have variable effects on CRP levels. Hydrochlorothiazide and oral estrogen do not affect CRP. The CRP-lowering effect of statins is more pronounced than their lipid lowering effect and is not dependent on their hypolipemic activity. The effect of atorvastatin on CRP seems to be dose-dependent. CRP-lowering effect of statins is likely to contribute to the favorable outcome of statin therapy. The data suggest that lipid lowering agents, ACE inhibitors, ARBs, antidiabetic agents, antiinflammatory and antiplatelet agents, vitamin E, and beta-adrenoreceptor antagonists lower serum or plasma levels of CRP, while vitamin C, oral estrogen and hydrochlorothiazide do not affect CRP levels.

High-sensitivity C-reactive protein and parameters of left ventricular dysfunction

BACKGROUND

Elevated levels of high-sensitivity C-reactive protein (CRP), an inflammatory marker, have been associated with heart failure. However, it is not known which parameters of left ventricular dysfunction correlate with elevated levels of CRP.

METHODS AND RESULTS

In this cross-sectional study of 98 patients referred for cardiac catheterization, we investigated whether commonly used clinical indices of left ventricular dysfunction correlated with CRP levels. CRP levels were elevated to a greater degree in participants with diabetes mellitus (P =.006) and heart failure (P =.003). Increased CRP levels were associated with increased plasma levels of B-type natriuretic peptide (BNP; P =.0001), decreased left ventricular ejection fraction (LVEF; P =.02), and increased left-ventricular end-diastolic pressure (LVEDP; P =.0005). After multivariable adjustment, LVEDP and CRP were independently associated (P =.046).

CONCLUSION

CRP is increased in patients with heart failure. Of the clinical parameters of left ventricular dysfunction, direct measurement of left ventricular end-diastolic pressure is most closely associated with CRP.

Markers of inflammation in acute coronary syndromes: association with increased heart rate and reductions in heart rate variability

BACKGROUND

Systemic and vascular inflammation is at the heart of the thrombotic occlusion of coronary arteries.

HYPOTHESIS

The study was undertaken to determine the relationship between established inflammatory markers (interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hs-CRP]), neutrophil or white cell count, and concomitant autonomic tone in patients with coronary artery disease soon after occlusive events.

METHODS

We tested the linkage between autonomic tone (as defined using both time domain and frequency domain estimates of heart rate variability [HRV]) and circulating markers of inflammation (white cell counts, hs-CRP, and IL-6) in a sample of 100 patients with proven acute coronary syndrome and compared these with healthy controls (n = 49) and the relationships on repeated measures at 4 months in recovery (n = 51).

RESULTS

We demonstrated predictable depressed HRV in acute patients who tended to show recovery by 4 months. The acute changes in HRV indices (e.g., triangular index) showed modest negative correlation (r = -0.2-0.3) with the acute elevation of white cell count, IL-6, and hs-CRP. These associations did not persist on multivariate analysis of data gathered at 4 months post event.

CONCLUSION

These observational data, while limited, are the first to link autonomic tone and in particular sympathetic tone (as indicated by HRV), to the process of acute leukocytosis and systemic inflammation common in acute coronary syndromes.

Effects of Fenofibrate on C-reactive Protein Levels in Hypertriglyceridemic Patients

We investigated the effects of fenofibrate on C-reactive protein (CRP) levels in patients with hypertriglyceridemia. Patients with a triglyceride level >or=200 mg/dL were randomly assigned to receive either 200 mg of fenofibrate (n = 54) or general measures (n = 54). A third group of patients with hypercholesterolemia received a statin (n = 54). Patients with a CRP level >or=10 mg/L were excluded. CRP levels were measured before and after 2 months of therapy. Fenofibrate did not reduce CRP levels (1.74 +/- 1.74 vs. 1.54 +/- 1.66 mg/L, P = 0.27) nor did general measures (P = 0.85). Statin reduced CRP levels (P = 0.002). In patients with baseline CRP levels of >or=3 mg/dL, CRP levels were decreased in both the fenofibrate and control groups (P = 0.026 and 0.008, respectively). Changes in CRP levels were associated only with baseline CRP levels in both groups (P = 0.001 and 0.049, respectively). When all hypertriglyceridemic patients were divided into 2 subgroups according to changes in body weights, CRP levels decreased in patients who reduced their body weight >or=1 kg (n = 29, P = 0.030), and were not changed in the other patients (n = 79, P = 0.67). In summary, fenofibrate failed to decrease CRP levels in patients with hypertriglyceridemia. An anti-inflammatory mechanism may not play a significant role in the cardioprotective effect of fenofibrate.

Correlation Between Inflammation and Oxidative Stress in Normocholesterolemic Coronary Artery Disease Patients ‘on’ and ‘off’ Atorvastatin for Short Time Intervals

AIM OF THE STUDY

To assess whether variations in antioxidant and anti-inflammatory parameters occur with short term administration and discontinuation of atorvastatin in normocholesterolemic coronary artery disease (CAD) patients.

METHODS

Forty CAD patients with near normal serum cholesterol levels (total cholesterol <240 mg/dl, LDL cholesterol <130 mg/dl) were continuously enrolled and randomized to groups A and B (20 patients taking atorvastatin) and groups C and D (20 patients not taking atorvastatin). Atorvastatin (10 mg/day) was continued in group A, withdrawn in group B and started in groups C and D for 6 weeks. Thereafter atorvastatin was withdrawn in group A and C, restarted in group B, and continued in group D for further 6 weeks. CRP, FRAP and TBARS were assessed at baseline, 6 weeks and 12 weeks in all the groups.

RESULTS

Baseline CRP, TBARS and FRAP levels were significantly different (p < 0.05) between groups A and B and C and D at the time of enrollment, indicating lower levels of oxidative stress (FRAP-172.40 +/- 23.41 nmol Fe(2+)/l vs 142.62 +/- 15.73 nmol Fe(2+)/l and TBARS-3.66 +/- 1.14 nmol/ml vs 6.11 +/- 1.85 nmol/ml) and low grade inflammation (CRP-1.38 +/- 0.69 mg/l vs 3.19 +/- 1.77 mg/l) in statin treated groups. In group B, discontinuation resulted in increase in CRP (2.87 +/- 0.98 mg/l) and TBARS (5.75 +/- 1.35 nmol/ml) and decrease in FRAP (133.132 +/- 13.32 nmol Fe(2+)/l) and whereas group A patients did not show significant variation in values compared to baseline (CRP-1.36 +/- 0.33 mg/l, FRAP-155.45 +/- 19.51 and TBARS-4.22 +/- 0.81). Administration of atorvastatin caused a marked reduction in oxidative stress and inflammation in groups C and D (CRP-1.13 +/- 0.99 mg/l and 1.73 +/- 1.60 mg/l, FRAP-166.54 +/- 34.11 and 177.44 +/- 13.31 nmol Fe(2+)/l, TBARS-4.66 +/- 2.33 and 3.55 +/- 1.25 nmol/ml respectively). The values returned to pretreatment levels on discontinuation of the drug in group C (CRP-2.61 +/- 1.28 mg/l, FRAP-138.49 +/- 19.62 nmol Fe(2+)/l, TBARS-6.13 +/- 0.74 nmol/ml) whereas the decline was maintained in group D (CRP-1.62 +/- 1.48 mg/l, FRAP-173.07 +/- 9.03 nmol Fe(2+)/l, TBARS-3.75 +/- 1.03 nmol/ml).

CONCLUSION

Administration and withdrawal of atorvastatin caused changes in markers of oxidative stress which closely correlated with changes in marker of inflammation. Further, the salutary effects were of quick onset, but were rapidly reversed on withdrawal of atorvastatin.

Enhanced oxidative stress and endothelial dysfunction in streptozotocin-diabetic rats exposed to fine particles

The association between ambient particulate matter (PM) and cardiovascular diseases has been demonstrated in epidemiological studies. Recent studies suggest that diabetic patients are at greater risk for PM-associated cardiovascular events. Although diabetes and PM exposure individually have been reported to be associated with increased oxidative stress, inflammation, and endothelial dysfunction, it is not clear whether PM may induce synergistic interaction effects on these parameters in diabetics. Strepotozotocin-induced diabetic (n=4) and healthy (n=4) rats were intratracheally administered with PM2.5 collected from a busy traffic area in a dose of 200 microg suspended in 0.5 mL phosphate-buffered saline (PBS). The same number of rats was exposed to PBS as controls. Cell and differential counts and protein and lactate dehydrogenase activity were determined in bronchoalveolar lavage. Markers of 8-hydroxydeoxy-guanosine (8-OHdG), endothelin-1 (ET-1), and [nitrate+nitrite], an indicator of nitric oxide (NO) production, in addition to C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in peripheral blood were also determined. Our results showed that diabetic rats were associated with increased 8-OHdG, IL-6, and ET-1 decreased [nitrate+nitrite]. In nondiabetic rats PM exposure was also associated with increased 8-OHdG, IL-6, TNF-alpha, and CRP but decreased [nitrate+nitrite]. Interestingly, increases of 8-OHdG and ET-1 after PM exposure were more prominent in diabetic rats than in nondiabetic rats. The general linear model further indicated that there were interactions between diabetes and PM on 8-OHdG (P<0.01) and ET-1 (P=0.08). We suggest that PM exposure may enhance the risk of cardiovascular diseases through interaction between PM and diabetes on excess reactive oxygen species generation and endothelial dysfunction. These findings provide further support for previous epidemiological studies.

Retinol-binding protein, transthyretin, and C-reactive protein in extremely low birth weight (ELBW) infants

BACKGROUND

Vitamin A deficiency reduces retinol binding protein (RBP) but not transthyretin (TTR), while inflammation reduces both RBP and TTR and increases C-reactive protein (CRP), an acute phase reactant.

OBJECTIVE

To estimate serum RBP, TTR, and CRP in ELBW infants to test the hypotheses that (a) TTR is a negative acute phase reactant and (b) a higher RBP/TTR ratio or CRP is associated with death/BPD by 36 weeks corrected age.

DESIGN/METHODS

Serum RBP, TTR, and CRP were measured in 79 ELBW infants at 28 days. Area under the curve (AUC) of receiver operating characteristic curve analysis evaluated the predictive value of TTR, the RBP/TTR ratio, and CRP for death/BPD at 36 weeks.

RESULTS

(1) TTR inversely correlated with CRP (r=-0.45, p<0.0001) consistent with TTR being a negative acute phase reactant. (2) The RBP/TTR ratio predicted death/BPD (AUC 0.68 (CI 0.57 to 0.78)). (3) CRP strongly predicted death/BPD (AUC 0.85 (CI 0.76 to 0.92)), even after exclusion of sepsis.

CONCLUSIONS

A higher CRP and RBP/TTR molar ratio on day 28 are associated with death/BPD at 36 weeks in ELBW infants. Lower TTR and maintained RBP/TTR ratios suggest inflammation rather than vitamin A deficiency as the cause for lower serum vitamin A levels in ELBW infants..

Effects of raloxifene, hormone therapy, and soy isoflavone on serum high-sensitive C-reactive protein in postmenopausal women

OBJECTIVE

To compare the effects of raloxifene, estradiol valerate plus dienogest, and soy isoflavones (genistein) on serum concentrations of high-sensitive C-reactive protein in healthy postmenopausal women.

METHODS

The 80 healthy postmenopausal women enrolled in the study were randomly allocated to receive 60 mg of raloxifene, 2 mg of estradiol valerate plus dienogest, 40 mg of genistein, or placebo (n=20 in each group). Blood samples were collected at the start of the study and at 3 and 6 months. Lipid profile was also determined.

RESULTS

Only the group receiving estradiol valerate plus dienogest showed an increase in serum levels of high-sensitive C-reactive protein compared with baseline values and values in the control and other groups. All 3 treatments resulted in an increase in high-density lipoprotein cholesterol levels and a decrease in total, low-density, and very-low-density lipoprotein cholesterol levels.

CONCLUSIONS

Estradiol valerate plus dienogest, but not raloxifene and genistein, increase serum high-sensitive C-reactive protein levels. All 3 treatments, however, have an estrogen-like effect on serum lipid profile.

Complement factor H polymorphism and age-related macular degeneration

Age-related macular degeneration (AMD) is a common, late-onset, and complex trait with multiple risk factors. Concentrating on a region harboring a locus for AMD on 1q25-31, the ARMD1 locus, we tested single-nucleotide polymorphisms for association with AMD in two independent case-control populations. Significant association (P = 4.95 x 10(-10)) was identified within the regulation of complement activation locus and was centered over a tyrosine-402 --> histidine-402 protein polymorphism in the gene encoding complement factor H. Possession of at least one histidine at amino acid position 402 increased the risk of AMD 2.7-fold and may account for 50% of the attributable risk of AMD.

Optimal lipid modification: the rationale for combination therapy

BACKGROUND

An emphasis on more aggressive lipid-lowering, particularly of low-density lipoprotein cholesterol, to improve patient outcomes has led to an increased use of combination lipid-lowering drugs. This strategy, while potentially beneficial, has triggered concerns regarding fears of adverse effects, harmful drug interactions, and patient nonadherence.

OBJECTIVE

To present key data regarding combination lipid-altering therapy including use, rationale, major trials, benefits, potential adverse effects, compliance issues, and limitations.

METHOD

Literature was obtained from MEDLINE (1966 - June 2005) and references from selected articles.

RESULTS

A substantial body of evidence from epidemiological data and clinical trials indicates that aggressive lipid modification, especially low-density lipoprotein reduction, is associated with reduced cardiovascular events. Numerous studies utilizing various combinations of cholesterol-lowering agents including statin/fibrate, statin/niacin, statin/bile acid resin, and statin/ezetimibe have demonstrated significant changes in the lipid profile with acceptable safety. Long-term trials of combination therapy evaluating clinical outcomes or surrogate markers of cardiovascular disease, while limited, are promising.

CONCLUSION

Combining lipid-altering agents results in additional improvements in lipoproteins and has the potential to further reduce cardiovascular events beyond that of monotherapy.

Glitazones and the management of insulin resistance: what they do and how might they be used

Thiazolidinediones (glitazones) are the only compounds currently available that specifically target tissue insulin resistance. The two currently available drugs in this class, pioglitazone and rosiglitazone,are approved by the Food and Drug Administration for the treatment of type 2 diabetes mellitus only. The therapeutic potential of the glitazones for other consequences of insulin resistance has stirred considerable interest, especially with regard to their potential beneficial impact on atherosclerotic cardiovascular disease and diabetes prevention. They also have been considered in the management of polycystic ovarian syndrome, nonalcoholic fatty liver disease, and other consequences of insulin resistance. The nonglycemic potential of glitazones is a clinical area in rapid evolution, wherein most data are on the impact of the glitazones onsurrogate markers that are associated with diseases, not on disease outcomes. This article provides insight and guidance to clinicians on the diverse nonglycemic potential of glitazones until conclusive outcome data become available.

Clinical application of genetic risk assessment strategies for coronary artery disease: genotypes, phenotypes, and family history

Individuals with genetic predisposition to atherosclerosis have an increased risk for developing coronary artery disease (CAD), especially at young ages. They may derive the greatest benefit from traditional preventive strategies and strategies targeting novel,emerging risk factors. Because CAD is a complex, multifactorial disorder, global risk assessment has been recognized as an effective approach in preventing CAD and its manifestations. The systematic collection and interpretation of family history information is currently the most appropriate screening approach to identify individuals with genetic susceptibility to CAD. Much of the familial aggregation of CAD might be explained by familial aggregation of established risk factors and emerging CAD risk factors. Tests to assess genetic risk for CAD are primarily biochemical analyses that measure the different pathways involved in development and progression of disease. Some of these can guide and explain responses to treatment.