1
|
Wu Z, Zhang C, Liu N, Xie W, Yang J, Guo H, Chi J. A Nomogram for Predicting Patent Foramen Ovale-Related Stroke Recurrence. Front Neurol 2022; 13:903789. [PMID: 35756923 PMCID: PMC9218274 DOI: 10.3389/fneur.2022.903789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background The high prevalence of patent foramen ovale (PFO) in cryptogenic stroke suggested a stroke-causing role for PFO. As risk factors for recurrence of such stroke are not recognized, clinicians cannot sufficiently identify, treat, and follow-up high-risk patients. Therefore, this study aimed to establish a prediction model for PFO-related stroke recurrence. Methods This study included 392 patients with PFO-related stroke in a training set and 164 patients with PFO-related stroke in an independent validation set. In the training set, independent risk factors for recurrence identified using forward stepwise Cox regression were included in nomogram 1, and those identified using least absolute shrinkage and selection operator(LASSO)regression were included in nomogram 2. Nomogram performance and discrimination were assessed using the concordance index (C-index), area under the curve (AUC), calibration curve, and decision curve analyses (DCA). The results were also validated in the validation set. Results Nomogram 1 was based on homocysteine (Hcy), high-sensitivity C-reactive protein (hsCRP), and albumin (ALB), and nomogram 2 was based on age, diabetes, hypertension, right-to-left shunt, ALB, prealbumin, hsCRP, and Hcy. The C-index of nomogram 1 was 0.861, which was not significantly different from that of nomogram 2 (0.893). The 2- and 5-year AUCs of nomogram 1 were 0.863 and 0.777, respectively. In the validation set, nomogram 1 still had good discrimination (C-index, 0.862; 2-year AUC, 0.839; 5-year AUC, 0.990). The calibration curve showed good homogeneity between the prediction by nomogram 1 and the actual observation. DCA demonstrated that nomogram 1 was clinically useful. Moreover, patients were successfully divided into two distinct risk groups (low and high risk) for recurrence rate by nomogram 1. Conclusions Nomogram 1, based on Hcy, hsCRP, and ALB levels, provided a more clinically realistic prognostic prediction for patients with PFO-related stroke. This model could help patients with PFO-related stroke to facilitate personalized prognostic evaluations.
Collapse
Affiliation(s)
- Zhuonan Wu
- Shaoxing University School of Medicine, Shaoxing, China
| | | | - Nan Liu
- Zhejiang Chinese Medical University of Medicine, Hangzhou, China
| | - Wenqing Xie
- Zhejiang Chinese Medical University of Medicine, Hangzhou, China
| | - Jinjin Yang
- Zhejiang University School of Medicine, Hangzhou, China
| | - Hangyuan Guo
- Department of Cardiology, The First Affiliated Hospital of Shaoxing University (Shaoxing People's Hospital), Shaoxing, China
| | - Jufang Chi
- Department of Cardiology, The First Affiliated Hospital of Shaoxing University (Shaoxing People's Hospital), Shaoxing, China
| |
Collapse
|
2
|
Jiang Y, Zhang X, Ma R, Wang X, Liu J, Keerman M, Yan Y, Ma J, Song Y, Zhang J, He J, Guo S, Guo H. Cardiovascular Disease Prediction by Machine Learning Algorithms Based on Cytokines in Kazakhs of China. Clin Epidemiol 2021; 13:417-428. [PMID: 34135637 PMCID: PMC8200454 DOI: 10.2147/clep.s313343] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Accurately identifying subjects at high-risk of CVD may improve CVD outcomes. We sought to systematically examine the feasibility and performance of 7 widely used machine learning (ML) algorithms in predicting CVD risks. Methods The final analysis included 1508 Kazakh subjects in China without CVD at baseline who completed follow-up. All subjects were randomly divided into the training set (80%) and the test set (20%). L1-penalized logistic regression (LR), support vector machine with radial basis function (SVM), decision tree (DT), random forest (RF), k-nearest neighbors (KNN), Gaussian naive Bayes (NB), and extreme gradient boosting (XGB) were employed for prediction CVD outcomes. Ten-fold cross-validation was used during model developing and hyperparameters tuning in the training set. Model performance was evaluated in the test set in light of discrimination, calibration, and clinical usefulness. RF was applied to obtain the variable importance of included variables. Twenty-two variables, including sociodemographic characteristics, medical history, cytokines, and synthetic indices, were used for model development. Results Among 1508 subjects, 203 were diagnosed with CVD over a median follow-up of 5.17 years. All 7 models had moderate to excellent discrimination (AUC ranged from 0.770 to 0.872) and were well calibrated. LR and SVM performed identically with an AUC of 0.872 (95% CI: 0.829–0.907) and 0.868 (95% CI: 0.825–0.904), respectively. LR had the lowest Brier score (0.078) and the highest sensitivity (97.1%). Decision curve analysis indicated that SVM was slightly better than LR. The inflammatory cytokines, such as hs-CRP and IL-6, were identified as strong predictors of CVD. Conclusion SVM and LR can be applied to guide clinical decision-making in the Kazakh Chinese population, and further study is required to ensure their accuracies.
Collapse
Affiliation(s)
- Yunxing Jiang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Xianghui Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Rulin Ma
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Xinping Wang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Jiaming Liu
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Mulatibieke Keerman
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Yizhong Yan
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Jiaolong Ma
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Yanpeng Song
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China.,The First Affiliated Hospital of Shihezi University Medical College, Shihezi, Xinjiang, People's Republic of China
| | - Jingyu Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Jia He
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Shuxia Guo
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China.,Department of Pathology and Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| | - Heng Guo
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People's Republic of China
| |
Collapse
|
3
|
Hagita T, Shiotani S, Toyama N, Tominaga N, Miyazaki H, Ogasawara N. Cardiac gas on immediate postmortem computed tomography after cardiopulmonary resuscitation indicates the progression of anaerobic metabolism. FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
4
|
Yang X, Zhang D, Zhao Y, Liu D, Li Q, Guo C, Tian G, Han M, Qie R, Huang S, Zhou Q, Zhao Y, Feng Y, Wu X, Zhang Y, Li Y, Wu Y, Cheng C, Hu D, Sun L. Association between serum level of C-reactive protein and risk of cardiovascular events based on cohort studies. J Hum Hypertens 2021; 35:1149-1158. [PMID: 33980977 DOI: 10.1038/s41371-021-00546-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022]
Abstract
Although the association between serum level of C-reactive protein (CRP) and risk of cardiovascular events (CVEs) has been reported, the comprehensive assessment of the quantitative association of CRP level with risk of CVEs has not been reported. Our meta-analysis aims to quantitatively evaluate the association of CRP level and risk of CVEs. We searched PubMed and Embase databases for articles published up to December 6, 2019. Studies with data on men and women, different types of CVEs and multiple cohorts within a study were treated as independent studies. Generalized least-squares regression models were used to assess the quantitative association between CRP level and risk of CVEs. Restricted cubic splines were used to model the possible linear association between CRP and CVEs. We included 36 articles (60 studies; 227,715 participants) in the analysis. The pooled relative risks (RRs) of high versus low CRP level for cardiovascular disease (CVD), stroke and coronary heart disease (CHD) were 1.64 (95% confidence interval [CI], 1.49-1.82), 1.46 (95% CI, 1.35-1.58), and 1.55 (95% CI, 1.47-1.63), respectively. A linear association was found between CRP level and CVD (P = 0.429), stroke (P = 0.940), and CHD (P = 0.931); with each 1-mg/L increase in CRP level, the pooled RRs for CVD, stroke, and CHD were 1.18 (95% CI, 1.12-1.24), 1.07 (95% CI, 1.04-1.09), and 1.12 (95% CI, 1.08-1.16), respectively. This meta-analysis suggests that risk of CVEs increases with increasing serum CRP level.
Collapse
Affiliation(s)
- Xingjin Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongdong Zhang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.,Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Quanman Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Chunmei Guo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Minghui Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qionggui Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yifei Feng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaoyan Wu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yanyan Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yang Li
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yuying Wu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Cheng Cheng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Liang Sun
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| |
Collapse
|
5
|
Letchumanan I, Arshad MKM, Gopinath SCB. Nanodiagnostic Attainments and Clinical Perspectives on C-Reactive Protein: Cardiovascular Disease Risks Assessment. Curr Med Chem 2021; 28:986-1002. [PMID: 31971105 DOI: 10.2174/0929867327666200123092648] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/12/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023]
Abstract
Cardiovascular disease (CVD) has become one of the leading causes of morbidity and mortality in both men and women. According to the World Health Organization (WHO), ischemic heart disease is the major issue due to the narrowing of the coronary artery by plaque formation on the artery wall, which causes an inadequate flow of oxygen and blood to the heart and is called 'coronary artery disease'. The CVD death rate increased by up to 15% in 2016 (~17.6 million) compared to the past decade. This tremendous increment urges the development of a suitable biomarker for rapid and early diagnosis. Currently, C-reactive protein (CRP) is considered an outstanding biomarker for quick and accurate outcomes in clinical analyses. Various techniques have also been used to diagnose CVD, including surface plasmon resonance (SPR), colorimetric assay, enzyme-linked immunosorbent assay (ELISA), fluoro-immunoassays, chemiluminescent assays, and electrical measurements. This review discusses such diagnostic strategies and how current, cutting-edge technologies have enabled the development of high-performance detection methodologies. Concluding remarks have been made concerning the clinical significance and the use of nanomaterial in medical diagnostics towards nanotheranostics.
Collapse
Affiliation(s)
- Iswary Letchumanan
- Institute of Nano Electronic Engineering, Universiti Malaysia Perlis, 01000 Kangar, Perlis, Malaysia
| | - M K Md Arshad
- Institute of Nano Electronic Engineering, Universiti Malaysia Perlis, 01000 Kangar, Perlis, Malaysia
| | - Subash C B Gopinath
- Institute of Nano Electronic Engineering, Universiti Malaysia Perlis, 01000 Kangar, Perlis, Malaysia
| |
Collapse
|
6
|
Meri S, Haapasalo K. Function and Dysfunction of Complement Factor H During Formation of Lipid-Rich Deposits. Front Immunol 2020; 11:611830. [PMID: 33363547 PMCID: PMC7753009 DOI: 10.3389/fimmu.2020.611830] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023] Open
Abstract
Complement-mediated inflammation or dysregulation in lipid metabolism are associated with the pathogenesis of several diseases. These include age-related macular degeneration (AMD), C3 glomerulonephritis (C3GN), dense deposit disease (DDD), atherosclerosis, and Alzheimer’s disease (AD). In all these diseases, formation of characteristic lipid-rich deposits is evident. Here, we will discuss molecular mechanisms whereby dysfunction of complement, and especially of its key regulator factor H, could be involved in lipid accumulation and related inflammation. The genetic associations to factor H polymorphisms, the role of factor H in the resolution of inflammation in lipid-rich deposits, modification of macrophage functions, and complement-mediated clearance of apoptotic and damaged cells indicate that the function of factor H is crucial in limiting inflammation in these diseases.
Collapse
Affiliation(s)
- Seppo Meri
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland.,Department of Bacteriology and Immunology, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Karita Haapasalo
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| |
Collapse
|
7
|
Hamjane N, Benyahya F, Nourouti NG, Mechita MB, Barakat A. Cardiovascular diseases and metabolic abnormalities associated with obesity: What is the role of inflammatory responses? A systematic review. Microvasc Res 2020; 131:104023. [PMID: 32485192 DOI: 10.1016/j.mvr.2020.104023] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Obesity is a chronic disease responsible for a high morbidity and mortality rate, with an increasing worldwide prevalence. Obesity is associated with immune responses characterized by chronic systemic inflammation. This article focuses on the mechanisms that explain the proposed link between obesity-associated diseases and inflammation. Also, it describes the role of inflammatory molecules in obesity-associated metabolic abnormalities. METHODS More than 200 articles were selected and consulted by an online English search using various electronic search databases. Predefined key-words for the pathogenesis of obesity-induced inflammation and associated diseases, as well as the role of various inflammatory molecules, were used. RESULTS We have summarized the data of the articles consulted in this research and we have found that obesity is associated with a low-grade inflammation resulting from the change of adipose tissue (AT). The AT produces a variety of inflammatory molecules called adipocytokines that are involved in the onset of systemic low-grade inflammation which is the link between obesity and associated-chronic abnormalities; such as insulin resistance, metabolic syndrome, cardiovascular disease (CVD), hypertension, diabetes, and some cancers. Also, we have searched all the inflammatory molecules involved in this pathogenesis and we have briefly described the role of 16 of them which are the most related to obesity-associated inflammation. The results have shown that there are inflammatory molecules that have a positive relationship with the pathogenesis of obesity-related diseases and others have a negative relationship with this pathogenesis. CONCLUSION Inflammation plays a crucial role in the development of various metabolic-abnormalities related to obesity. In this regard, the management of obesity may help reduce the risk of cardiovascular disease and other metabolic complications by inhibiting inflammatory mechanisms.
Collapse
Affiliation(s)
- Nadia Hamjane
- Laboratory of Biomedical Genomics and Oncogenetics, Faculty of Sciences and Technology, Abdelmalek Essaadi University, Tangier, Morocco.
| | | | - Naima Ghailani Nourouti
- Laboratory of Biomedical Genomics and Oncogenetics, Faculty of Sciences and Technology, Abdelmalek Essaadi University, Tangier, Morocco
| | - Mohcine Bennani Mechita
- Laboratory of Biomedical Genomics and Oncogenetics, Faculty of Sciences and Technology, Abdelmalek Essaadi University, Tangier, Morocco
| | - Amina Barakat
- Laboratory of Biomedical Genomics and Oncogenetics, Faculty of Sciences and Technology, Abdelmalek Essaadi University, Tangier, Morocco
| |
Collapse
|
8
|
Pro-inflammatory cytokines, oxidative stress and diffuse coronary reocclusions in elderly patients after coronary stenting. Cytokine 2020; 129:155028. [DOI: 10.1016/j.cyto.2020.155028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/12/2019] [Accepted: 02/03/2020] [Indexed: 01/04/2023]
|
9
|
Matijaca H, Gaćina P, Rinčić G, Matijaca A, Josipović J, Stojsavljević S. EFFECTS OF OCCUPATIONAL STRESS ON THE ACTIVATION OF HEMOSTATIC AND INFLAMMATORY SYSTEM. Acta Clin Croat 2019; 58:281-287. [PMID: 31819324 PMCID: PMC6884371 DOI: 10.20471/acc.2019.58.02.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A 24-hour shift is one of the major stressors for physicians because, apart from causing fatigue and circadian rhythm disorders, it often requires making vital decisions for patients within a short time frame. It is known that workplace stress leads to the activation of the coagulation system, which can result in imbalance of the coagulation and fibrinolysis system. The state of stress can also generate proinflammatory mediators. The aim of this study was to examine the effect of 24-hour shift on global coagulation tests of D-dimers and fibrinolysis, and on C-reactive protein (CRP) as an acute inflammatory agent and proatherosclerotic factor. Sixty physicians (residents) aged 25-35 participated in this study (30 participants in the experimental group and 30 participants in the control group). In experimental group, blood samples were collected on three occasions: shortly before 24-hour shift, twelve hours after the shift had begun, and at the end of the shift. Blood samples were collected from control group participants at the same time points. The results showed that there was no statistically significant difference in the values of D-dimer and fibrinolysis between the experimental and control groups. CRP values were statistically significantly higher in the experimental (1.57, 1.49 and 1.50) than in the control group (0.79, 0.75 and 0.84) on all three measurements (p=0.024, p=0.020 and p=0.030, respectively). These results confirmed the existence of proinflammatory changes in the endothelium of blood vessels, which is a factor associated with accelerated atherosclerosis.
Collapse
Affiliation(s)
| | - Petar Gaćina
- 1Division of Hematology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Division of Endocrinology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 3Division of Nephrology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Division of Gastroenterology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Goran Rinčić
- 1Division of Hematology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Division of Endocrinology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 3Division of Nephrology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Division of Gastroenterology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ana Matijaca
- 1Division of Hematology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Division of Endocrinology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 3Division of Nephrology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Division of Gastroenterology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Josipa Josipović
- 1Division of Hematology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Division of Endocrinology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 3Division of Nephrology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Division of Gastroenterology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Sanja Stojsavljević
- 1Division of Hematology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Division of Endocrinology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 3Division of Nephrology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4Division of Gastroenterology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| |
Collapse
|
10
|
Kechagias A, Sofianidis A, Zografos G, Leandros E, Alexakis N, Dervenis C. Index C-reactive protein predicts increased severity in acute sigmoid diverticulitis. Ther Clin Risk Manag 2018; 14:1847-1853. [PMID: 30323607 PMCID: PMC6174315 DOI: 10.2147/tcrm.s160113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Conservative management is successful in unperforated (Hinchey Ia) acute diverticulitis (AD) and also generally in local perforation or small abscesses (Hinchey Ib). A higher degree of radiological severity (Hinchey >Ib), ie, a larger abscess (>3-4 cm) or peritonitis, commonly requires percutaneous drainage or surgery. Retrospective studies show that high levels of C-reactive protein (CRP) distinguish Hinchey Ia from all cases of minor and major perforations (Hinchey >Ia). The current study aims to evaluate the usefulness of CRP in distinguishing AD with a higher degree of severity (Hinchey >Ib) from cases that can be treated noninvasively (Hinchey Ia/Ib). Methods Data from consecutive patients with AD were collected prospectively. All underwent computed tomography (CT). Index parameters obtained at the initial evaluation at the emergency unit were analyzed to assess the association with the outcome. The exclusion criteria comprised concomitant conditions that affected CRP baseline levels. Results Ninety-nine patients were analyzed. Eighty-eight had mild radiological grading (Hinchey Ia/Ib), and 11 had severe radiological grading (Hinchey >Ib) (median index CRP 80 mg/L vs 236 mg/L [P<0.001]). White blood cells, neutrophils/lymphocytes, serum creatinine, serum glucose, generalized peritonitis, generalized abdominal tenderness, urinary symptoms, and index CRP were related to severe disease. Index CRP was the only independent predictor for Hinchey >Ib (P=0.038). The optimal cutoff value calculated by receiver operating characteristic curve analysis was found to be 173 mg/L (sensitivity 90.9%, specificity 90.9%, P<0.001). All patients who underwent radiological drainage or surgery had an index CRP >173 mg/L and Hinchey >Ib. Conclusion CRP levels >173 mg/L obtained at the initial evaluation at the emergency unit predict major acute complications in AD. These patients commonly require urgent percutaneous drainage or surgical management.
Collapse
Affiliation(s)
- Aristotelis Kechagias
- Department of Surgery, Konstantopouleion Hospital, Athens, Greece, .,Department of Gastrointestinal Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland,
| | | | - Georgios Zografos
- First Department of Propaedeutic Surgery, Hippocratio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouel Leandros
- First Department of Propaedeutic Surgery, Hippocratio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicholas Alexakis
- First Department of Propaedeutic Surgery, Hippocratio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
11
|
Intraplaque Expression of C-Reactive Protein Predicts Cardiovascular Events in Patients with Severe Atherosclerotic Carotid Artery Stenosis. Mediators Inflamm 2016; 2016:9153673. [PMID: 27738391 PMCID: PMC5050375 DOI: 10.1155/2016/9153673] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/22/2016] [Indexed: 01/15/2023] Open
Abstract
Serum c-reactive protein (CRP) was suggested for the assessment of intermediate cardiovascular (CV) risk. Here, systemic or intraplaque CRP levels were investigated as predictors of major adverse cardiovascular events (MACEs) in patients with severe carotid stenosis. CRP levels were assessed in the serum and within different portions (upstream and downstream) of carotid plaques of 217 patients undergoing endarterectomy. The association between CRP and intraplaque lipids, collagen, neutrophils, smooth muscle cells (SMC), and macrophage subsets was determined. No correlation between serum CRP and intraplaque biomarkers was observed. In upstream portions, CRP content was directly correlated with intraplaque neutrophils, total macrophages, and M1 macrophages and inversely correlated with SMC content. In downstream portions, intraplaque CRP correlated with M1 and M2 macrophages. According to the cut-off point (CRP > 2.9%) identified by ROC analysis in upstream portions, Kaplan-Meier analysis showed that patients with high CRP levels had a greater rate of MACEs. This risk of MACEs increased independently of age, male gender, serum CRP, and statin use. In conclusion, in patients with severe carotid artery stenosis, high CRP levels within upstream portions of carotid plaques directly and positively correlate with intraplaque inflammatory cells and predict MACEs at an 18-month follow-up period.
Collapse
|
12
|
Antioxidant and anti-inflammatory effects of flavocoxid in high-cholesterol-fed rabbits. Naunyn Schmiedebergs Arch Pharmacol 2015; 388:1333-44. [DOI: 10.1007/s00210-015-1168-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 08/16/2015] [Indexed: 02/06/2023]
|
13
|
El-Sheakh AR, Ghoneim HA, Suddek GM, Ammar ESM. Attenuation of oxidative stress, inflammation, and endothelial dysfunction in hypercholesterolemic rabbits by allicin. Can J Physiol Pharmacol 2015; 94:216-224. [PMID: 26618400 DOI: 10.1139/cjpp-2015-0267] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Allicin, the active substance of garlic, exerts a broad spectrum of pharmacological activities and is considered to have potential therapeutic applications. The present study was designed to investigate the possible beneficial effects of allicin against oxidative stress, inflammation, and endothelial dysfunction in hypercholesterolemic rabbits. Male New Zealand white rabbits were used in this study. Rabbits randomly received 1 of the following treatments: normal chow diet for 4 weeks, 1% high cholesterol diet (HCD), HCD plus allicin (10 mg/kg/day), or HCD plus atorvastatin (10 mg/kg/day). Blood samples were collected at the end of experimental diets for measurement of serum total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), malondialdehyde (MDA), reduced glutathione (GSH), and superoxide dismutase (SOD). In addition, the aorta was removed for measurement of vascular reactivity, histopathological changes, intima/media (I/M) ratio, and immunohistochemical staining of both tumor necrosis-alpha (TNF-α) and nuclear factor (NF)-κB. HCD induced significant increases in serum TC, TGs, low-density lipoprotein cholesterol (LDL-C), CRP, and MDA. Moreover, HCD caused significant decrease in serum GSH and SOD. In addition, aortic relaxation response to acetylcholine (ACh) was impaired. Immunohistochemical staining of aortic specimens from HCD-fed rabbits revealed high expression levels of both TNF-α and the oxidant-induced transcription factor, NF-κB. Allicin supplementation significantly decreased serum MDA and CRP, increased serum HDL-C, GSH, and SOD levels while nonsignificantly affecting HCD-induced elevations in serum TC and LDL-C. Additionally, allicin significantly protected against HCD-induced attenuation of rabbit aortic endothelium-dependent relaxation to ACh and elevation in I/M ratio. This effect was confirmed by histopathological examination of the aorta. Moreover, allicin has substantially beneficial effects on aortic expression of TNF-α and NF-κB compared with HCD-fed rabbits. In conclusion, these findings demonstrate that allicin may be useful in reducing oxidative stress, inflammation, vascular dysfunction, and the aortic pathology in hypercholesterolemic rabbits.
Collapse
Affiliation(s)
- Ahmed R El-Sheakh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Hamdy A Ghoneim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Ghada M Suddek
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - El Sayed M Ammar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| |
Collapse
|
14
|
Parrinello CM, Lutsey PL, Ballantyne CM, Folsom AR, Pankow JS, Selvin E. Six-year change in high-sensitivity C-reactive protein and risk of diabetes, cardiovascular disease, and mortality. Am Heart J 2015; 170:380-9. [PMID: 26299237 DOI: 10.1016/j.ahj.2015.04.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/12/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Single measurements of elevated high-sensitivity C-reactive protein (hs-CRP) are associated with increased risk of diabetes, cardiovascular disease, and mortality. Large increases or sustained elevations in hs-CRP may be associated with even greater risk of these outcomes. The objective of this study was to characterize the association of 6-year change in hs-CRP with incident diabetes, incident cardiovascular events (heart disease, stroke, and heart failure), and mortality. METHODS We included 10,160 ARIC participants with hs-CRP measured at visits 2 (1990-1992) and 4 (1996-1998). Change in hs-CRP was categorized as sustained low/moderate (<3 mg/L at both visits), decreased (≥3 mg/L at visit 2 and <3 mg/L at visit 4), increased (<3 mg/L at visit 2 and ≥3 mg/L at visit 4), and sustained elevated (≥3 mg/L at both visits). Cox proportional hazards models were used to assess the association of 6-year change in hs-CRP with incident diabetes, cardiovascular events, and death during ~15 years after visit 4. RESULTS Compared with persons with sustained low/moderate hs-CRP, those with increased or sustained elevated hs-CRP had an increased risk of incident diabetes (hazard ratios [95% CIs] 1.56 [1.38-1.76] and 1.39 [1.25-1.56], respectively), whereas those with deceased hs-CRP did not. Persons with sustained elevated hs-CRP had an increased risk of coronary heart disease, ischemic stroke, heart failure, and mortality (hazard ratios [95% CIs] 1.51 [1.23-1.85], 1.70 [1.32-2.20], 1.60 [1.35-1.89], and 1.52 [1.37-1.69], respectively) compared with those with sustained low/moderate hs-CRP. Associations for sustained elevated hs-CRP were greater than for those with increased hs-CRP over 6 years. CONCLUSIONS Large increases or sustained elevations in hs-CRP over a 6-year period were associated with a subsequent increased risk of diabetes, and persons with sustained elevations in hs-CRP were at the highest risk for cardiovascular disease and mortality. Two measurements of hs-CRP are better than one for characterizing risk, and large increases are particularly prognostic.
Collapse
|
15
|
Yu YT, Ho CT, Hsu HS, Li CI, Davidson LE, Liu CS, Li TC, Shih CM, Lin CC, Lin WY. Subclinical hypothyroidism is associated with elevated high-sensitive C-reactive protein among adult Taiwanese. Endocrine 2013; 44:716-22. [PMID: 23468096 DOI: 10.1007/s12020-013-9915-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/26/2013] [Indexed: 01/07/2023]
Abstract
Subjects with subclinical hypothyroidism (SCH) are at increased risk for cardiovascular disease (CVD). High-sensitivity C-reactive protein (hsCRP) is one of the inflammatory markers related to CVD. It is unclear whether inflammation is a mechanistic intermediary between SCH and CVD. We aimed to investigate the association between SCH and hsCRP in a Taiwanese population. A baseline cohort of 2,494 participants over the age of 19 was recruited in Taiwan from 2006 to 2008. SCH was defined as a serum thyroid-stimulating hormone (TSH) level of 5.61-19.9 mIU/L with normal thyroxine concentrations (a total T4 level of 4.9-12.0 μg/dL). Euthyroidism was defined as a serum TSH level of 0.34-5.60 mIU/L. HsCPR was grouped using quartiles. Multiple logistic and linear regression analyses were used to evaluate the relationship between hsCRP and SCH. After adjusting for gender and betel nut chewing, stepwise multiple logistic regression analyses revealed that hsCRP groups were significantly associated with SCH. Compared to the lowest hsCRP quartile, the adjusted odds ratio of having SCH for hsCRP quartile II, III, and IV were 1.38 (0.48-3.98), 1.48 (0.56-3.96), and 2.59 (1.01-6.67), respectively. The significant increase in odds ratios for SCH in progressive hsCRP quartiles reveals a dose-response effect (p < 0.05). Moreover, stepwise multiple linear regression analyses showed that hsCRP was significantly positively associated with serum TSH level after adjusting for potential confounders. Adult Taiwanese with SCH were associated with elevated hsCRP quartiles.
Collapse
Affiliation(s)
- Ya-Ting Yu
- Department of Family Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 404, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Abd El-Aziz TA, Mohamed RH. Human C-reactive protein gene polymorphism and metabolic syndrome are associated with premature coronary artery disease. Gene 2013; 532:216-21. [PMID: 24055729 DOI: 10.1016/j.gene.2013.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/08/2013] [Accepted: 09/11/2013] [Indexed: 01/19/2023]
Abstract
The aim of this study was to investigate the association between C-reactive protein (CRP) gene polymorphism and metabolic syndrome (MetS) with premature coronary artery disease (PCAD). 116 patients with PCAD (58 with MetS and 58 without MetS) and 119 controls were included in the study. CRP gene +1059 G>C polymorphism was analyzed by polymerase chain reaction. Serum hs-CRP was measured using high-sensitivity enzyme-linked immunosorbent assay. Carriers of C allele of the CRP +1059 G>C polymorphism had 3.37 fold increased risk to develop MetS in patients with PCAD. In addition CRP gene and hs-CRP levels were independent risk factors for PCAD and MetS. The present study provides new evidence that the presence of CRP +1059 G>C polymorphism and hs-CRP levels are independent determinants of PCAD and MetS in Egyptians. The results of our study suggest a synergistic effect of CRP C allele with classical risk factors such as hypertension, obesity, dyslipidemia and MetS.
Collapse
Affiliation(s)
- Tarek A Abd El-Aziz
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | |
Collapse
|
17
|
Yang SJ, Kim S, Choi HY, Kim TN, Yoo HJ, Seo JA, Kim SG, Kim NH, Baik SH, Choi DS, Choi KM. High-sensitivity C-reactive protein in the low- and intermediate-Framingham risk score groups: Analysis with 18F-fluorodeoxyglucose positron emission tomography. Int J Cardiol 2013; 163:277-281. [DOI: 10.1016/j.ijcard.2011.06.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 04/27/2011] [Accepted: 06/06/2011] [Indexed: 11/30/2022]
|
18
|
Inflammatory cardiovascular risk biomarkers: update on novelties and limitations. Mediators Inflamm 2012; 2012:515692. [PMID: 22701275 PMCID: PMC3373150 DOI: 10.1155/2012/515692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 04/01/2012] [Indexed: 12/15/2022] Open
|
19
|
Montecucco F, Braunersreuther V, Viviani GL, Lenglet S, Mach F. Update on the Pathophysiological Role of Intracellular Signaling Pathways in Atherosclerotic Plaques and Ischemic Myocardium. ACTA ACUST UNITED AC 2012; 7:104-110. [PMID: 22754427 PMCID: PMC3382259 DOI: 10.2174/157436212800376663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 09/30/2011] [Accepted: 10/01/2011] [Indexed: 01/02/2023]
Abstract
Acute atherosclerotic complications, such as myocardial infarction, are often provoked by the rupture of an atherosclerotic plaque and the subsequent thrombotic occlusion of the arterial lumen, which interrupts the blood flow and renders ischemic the downstream peripheral tissue. Several inflammatory mediators (including cytokines, chemokines and matrix metalloproteases) have been shown to orchestrate common pathophysiological mechanisms regulating both plaque vulnerability and myocardial injury. In particular, the selective activation of certain protective intracellular signaling pathways might represent a promising target to reduce the dramatic consequences of an ischemic cardiac event. In the present review we will update evidence on the active role of intracellular kinase cascades (such as mitogen-activated protein kinases [MAPKs], Akt, Janus kinase [JAK]-signal transducer and activator of transcription [STAT]) to reduce the global patient vulnerability for acute myocardial infarction.
Collapse
Affiliation(s)
- Fabrizio Montecucco
- Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, University of Geneva, Geneva, Switzerland
| | | | | | | | | |
Collapse
|
20
|
Gisondi P, Malerba M, Malara G, Puglisi Guerra A, Sala R, Radaeli A, Calzavara-Pinton P, Girolomoni G. C-reactive protein and markers for thrombophilia in patients with chronic plaque psoriasis. Int J Immunopathol Pharmacol 2011; 23:1195-202. [PMID: 21244768 DOI: 10.1177/039463201002300423] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Chronic plaque psoriasis is associated to an increased risk of cardiovascular events. The aim of our study is to test patients with psoriasis for common markers of acquired and inherited thrombophilia. A cross-sectional study on 172 patients with psoriasis and 198 controls was carried out. The plasma levels of coagulation protein C, coagulation protein S, homocysteine, folic acid, C-reactive protein (CRP) and fibrinogen as well as activated protein C resistance and antithrombin III activity, were measured. CRP and homocysteine levels were higher in patients with psoriasis than in controls (5.9 ± 7.1 vs 3.1 ± 2.4 mg/L, p=0.0003 and 16.3 ± 12.8 vs 10.4 ± 4.6 umol/L, p=0.0001; mean ± SD) whereas folic acid was lower in psoriatic patients compared to controls (4.3 ± 7.2 vs 12.6 ± 7.9 p=0.006). Levels of coagulation protein C, coagulation protein S, fibrinogen as well as activated protein C resistance, antithrombin III activity were within normal ranges both in cases and controls. In a multivariate regression analysis, psoriasis severity was an independent predictor of higher CRP. In conclusion, high levels of serum CRP and homocysteine were found in patients with psoriasis, related to the severity of the disease. These data suggest that the increased risk of thrombotic cardiovascular events observed in psoriasis patients should be ascribed to an acquired rather than inherited thrombophilic status.
Collapse
Affiliation(s)
- P Gisondi
- Section of Dermatology, Department of Biomedical and Surgical Science, University of Verona, Italy
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Dhangana R, Murphy TP, Pencina MJ, Zafar AM. Prevalence of low ankle-brachial index, elevated plasma fibrinogen and CRP across Framingham risk categories: data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Atherosclerosis 2010; 216:174-9. [PMID: 21414621 DOI: 10.1016/j.atherosclerosis.2010.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 10/04/2010] [Accepted: 10/17/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE 60-80% of heart attacks or coronary-related deaths occur in individuals identified as non-high-risk per the conventional risk assessment algorithms. Abnormal ankle-brachial index (ABI), plasma fibrinogen and plasma C-reactive protein (CRP) have been shown to be associated with a higher risk of cardiovascular disease (CVD). However, comparable data have not been reported for prevalence of abnormal ABI, fibrinogen and CRP in non-high-risk population. METHODS We analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey of the U.S. population, for 6292 men and women, aged 40 and older, without known CVD or diabetes, with available data on standard CVD risk factors, ABI, fibrinogen and CRP. The main objective was to identify proportions of individuals with abnormal ABI (ABI<0.9 in either leg), elevated fibrinogen (≥ 400 mg/dl), and elevated CRP (>3mg/l), with otherwise low or intermediate (<20%) 10-year Framingham risk score. RESULTS Overall prevalence of abnormal ABI, fibrinogen, and CRP was 3.6% (95% CI 3.2-4.1%), 27.4% (95% CI 23.9-31.0%) and 38.3% (95% CI 36.5-40.0%) respectively. Among those with ABI data, 91.4% were at <20% FRS, and of these only 2.7% (95% CI 2.3-3.1%, p < 0.0001) had an abnormal ABI. Among those with fibrinogen data, 90.8% were at <20% FRS, and of these 23.6% (95% CI 20.4-26.8%, p < 0.001) had elevated plasma fibrinogen. Among those with CRP data, 91.1% were at <20% FRS, and of these 34.3% (95% CI 32.7-36.0%, p = 0.0012) had an elevated CRP. Overall, 45.0% (95% CI 42.2-47.8%; p < 0.0001) had abnormal ABI, fibrinogen or CRP but low-intermediate risk. CONCLUSION Abnormal ABI, elevate fibrinogen and CRP are highly prevalent among individuals otherwise at low-intermediate risk. If any or all of them are shown to improve predictive ability of FRS for primary prevention, it would have a significant public health impact.
Collapse
Affiliation(s)
- Rajoo Dhangana
- Vascular Disease Research Center, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, United States
| | | | | | | |
Collapse
|
22
|
Steinhardt AP, Aranguren F, Tellechea ML, Gómez Rosso LA, Brites FD, Martínez-Larrad MT, Serrano-Ríos M, Frechtel GD, Taverna MJ. A functional nonsynonymous toll-like receptor 4 gene polymorphism is associated with metabolic syndrome, surrogates of insulin resistance, and syndromes of lipid accumulation. Metabolism 2010; 59:711-7. [PMID: 19922963 DOI: 10.1016/j.metabol.2009.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 01/12/2023]
Abstract
Toll-like receptor 4 (TLR4) plays a key role in the activation of innate immune responses. Loss-of-function mutations in TLR4 prevent diet-induced obesity and insulin resistance (IR). We conducted a population cross-sectional study to evaluate whether Asp299Gly (rs4986790) TLR4 gene polymorphism is associated with metabolic syndrome (MS), surrogates of IR, and syndromes of lipid accumulation (SLAs) in Argentinean healthy male subjects. rs4986790 was genotyped in 621 healthy unrelated male blood donors. National Cholesterol Education Program/Adult Treatment Panel III-MS (NCEP/ATP III-MS); SLAs such as enlarged waist elevated triglyceride syndrome (EWET), hypertriglyceridemic waist (HW), and overweight-lipid syndrome (OLS); and surrogates of IR were assessed. The prevalence of MS, OLS, and EWET was significantly higher among Asp299Asp carriers (P < .05). These findings were confirmed using 32 000 bootstrap samples. Surrogate markers of IR were also significantly higher in Asp299Asp carriers (P < .05). Most findings were especially strengthened among individuals with C-reactive protein below the 95th percentile and/or total cholesterol to high-density lipoprotein cholesterol ratio >or=5. This is the first report to find, in Argentinean healthy male blood donors, associations between the Asp299Asp genotype of rs4986790 TLR4 gene polymorphism and high risk for NCEP/ATP III-MS, SLAs, and surrogates of IR. These findings are consistent with previous functional and observational studies showing that Asp299 allele, in comparison with Gly299, is associated with increased TLR4 activation, higher levels of inflammatory cytokines, acute-phase reactants and soluble adhesion molecules, and higher risk of atherosclerosis.
Collapse
Affiliation(s)
- Alberto Penas Steinhardt
- Humoral Immunity Institute Prof Ricardo A. Margni (IDEHU), National Research Council (CONICET) and School of Pharmacy and Biochemistry, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Nordestgaard BG. Does elevated C-reactive protein cause human atherothrombosis? Novel insights from genetics, intervention trials, and elsewhere. Curr Opin Lipidol 2009; 20:393-401. [PMID: 19667982 DOI: 10.1097/mol.0b013e3283307bfe] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To evaluate evidence from human epidemiology, mechanistic studies, animal studies, human genetics, and human intervention trials to address whether elevated C-reactive protein (CRP) causes human atherothrombotic cardiovascular disease. RECENT FINDINGS Human epidemiology demonstrates that elevated CRP levels are associated with increased risk of atherothrombosis. Mechanistic and animal studies provide evidence both for and against a causal relationship of CRP with atherothrombosis. Human genetics demonstrate that genetic variation in the CRP gene is associated with lifelong increased CRP levels, but not with increased risk of atherothrombosis. A human intervention trial in healthy people with low LDL cholesterol and elevated CRP demonstrated that aggressive statin treatment caused reductions of 50% in LDL cholesterol, 37% in CRP, 50% in atherothrombotic cardiovascular events, 20% in total mortality, and 45% in venothrombotic events. Importantly, the maximal atherothrombotic treatment benefits were obtained in those who achieved the lowest levels of both LDL cholesterol and CRP. SUMMARY Given the data available in mid-2009, elevated CRP per se does not seem to cause atherothrombotic cardiovascular disease, which questions whether CRP-reducing agents will prevent these diseases. However, inflammation per se possibly contributes to atherothrombotic and venothrombotic disease, and CRP measurement may be used in risk assessment and treatment monitoring in atherothrombotic cardiovascular disease.
Collapse
Affiliation(s)
- Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
24
|
HIV increases markers of cardiovascular risk: results from a randomized, treatment interruption trial. AIDS 2009; 23:929-39. [PMID: 19425222 DOI: 10.1097/qad.0b013e32832995fa] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Plasma soluble inflammatory molecules are associated with the risk of ischaemic cardiovascular events. We investigated whether HIV replication modified the levels of these proteins in a combination antiretroviral therapy (cART) interruption trial. METHOD AND RESULTS In 145 HIV-infected Thai patients (62% women, median CD4 cell count 271 cells/microl, median plasma HIV-RNA 4.66 log10 copies/ml) included in the Swiss-Thai-Australia Treatment Interruption Trial (STACCATO) trial, leptin, adiponectin, C-reactive protein, soluble vascular cell adhesion molecule-1 (s-VCAM-1), P-selectin, chemokine ligand 2, chemokine ligand 3, interleukin (IL)-6, IL-10, granulocyte macrophage colony-stimulating factor and D-dimer were measured before cART was initiated, after cART had suppressed HIV replication to less than 50 copies/ml plasma (median 8 months) and again 12 weeks after randomization to continued cART (n=48) or interrupted cART (n=97). Multiple linear regression and logistic regression were used to investigate the association between each cardiovascular marker and plasma HIV-RNA. Initiation of cART resulted in significant declines in s-VCAM-1, P-selectin, leptin and D-dimer, whereas mediators with anti-inflammatory properties, such as adiponectin and IL-10, increased. At 12 weeks after randomization, we found positive associations between levels of s-VCAM-1 and chemokine ligand 2 with an increase in plasma HIV-RNA (r=0.271, P=0.001 and r=0.24, P=0.005, respectively), whereas levels of adiponectin decreased for each 1 log increase in plasma HIVRNA (r=-0.24, P=0.002). Detectable IL-10 was less likely (odds ratio = 0.64, 95% confidence interval = 0.43-0.96) for each 1 log increase in plasma HIV-RNA. CONCLUSION Plasma levels of several inflammatory, anti-inflammatory and endothelial activation markers of cardiovascular disease are associated with HIV-RNA replication.
Collapse
|
25
|
|