High-Sensitivity C-Reactive Protein and Cardiovascular Disease Across Countries and Ethnicities

A Chemical Structure and Machine Learning Approach to Assess the Potential Bioactivity of Endogenous Metabolites and Their Association with Early Childhood Systemic Inflammation

Metabolomics has gained much attention due to its potential to reveal molecular disease mechanisms and present viable biomarkers. This work uses a panel of untargeted serum metabolomes from 602 children from the COPSAC2010 mother-child cohort. The annotated part of the metabolome consists of 517 chemical compounds curated using automated procedures. We created a filtering method for the quantified metabolites using predicted quantitative structure-bioactivity relationships for the Tox21 database on nuclear receptors and stress response in cell lines. The metabolites measured in the children's serums are predicted to affect specific targeted models, known for their significance in inflammation, immune function, and health outcomes. The targets from Tox21 have been used as targets with quantitative structure-activity relationships (QSARs). They were trained for ~7000 structures, saved as models, and then applied to the annotated metabolites to predict their potential bioactivities. The models were selected based on strict accuracy criteria surpassing random effects. After application, 52 metabolites showed potential bioactivity based on structural similarity with known active compounds from the Tox21 set. The filtered compounds were subsequently used and weighted by their bioactive potential to show an association with early childhood hs-CRP levels at six months in a linear model supporting a physiological adverse effect on systemic low-grade inflammation.

The Roles Played by Blood Inflammatory Parameters in Sudden Sensorineural Hearing Loss

OBJECTIVE

The etiology of sudden sensorineural hearing loss (SSNHL) remains unknown; inflammation may be one cause. We retrospectively studied SSHNL cases in terms of the inflammatory parameters involved.

METHODS

We reviewed 169 SSNHL cases. The control group contained 132 patients with vocal cord polyps. The C-reactive protein (CRP) level, CRP/serum albumin (Alb) ratio, and neutrophil/lymphocyte ratio (NLR) were compared between the 2 groups. The relationships between these parameters and the time to treatment after SSHNL onset, hearing level, and therapeutic effects were also analyzed.

RESULTS

The CRP level, CRP/Alb ratio, and NLR were higher in SSNHL patients than in controls, but only the NLR differed significantly between the 2 groups. We found no significant differences between patients with different hearing levels, those evaluated at various times after SSNHL onset, and those with different outcomes.

CONCLUSION

The NLR is a reliable SSNHL diagnostic marker. The CRP level and CRP/Alb ratio are not useful indicators.

Chronic Administration of Methamphetamine Aggravates Atherosclerotic Vulnerable Plaques in Apolipoprotein E Knockout Mice Fed with a High-cholesterol Diet

BACKGROUND

It has been observed previously that chronic methamphetamine (METH) administration could upregulate neuropeptide Y (NPY) expression and promote atherosclerotic formation in apolipoprotein E knockout (ApoE-/-) mice fed with a normal cholesterol or high diet and NPY might be involved in the pathogenesis of METHinduced atherogenic effects through NPY Y1 receptor pathway. Vulnerable coronary atherosclerotic plaque (VP) is a critical pathological finding responsible for the acute coronary syndrome (ACS). In this study, we explored whether METH abuse could aggravate the formation of VP in ApoE-/- mice fed with high cholesterol diet.

OBJECTIVE

The purpose of this study was to observe if chronic METH administration could aggravate vulnerable plaque (VP) formation in ApoE-/- mice fed with a highcholesterol diet.

METHODS

Male ApoE-/- mice fed with a high-cholesterol diet were intraperitoneally injected with normal saline (NS) or 8 mg/kg/day METH (M8) for 24 weeks. Body weight was monitored from baseline to 24 weeks at 2 weeks intervals. After 24 weeks of treatment, plasma lipid variables were measured. Movat's staining and immunohistochemical staining were performed on frozen sections of the aortic roots to calculate VP percentage and intraplaque hemorrhage (IPH) percentage and detect expression of NPY, vascular endothelial growth factor (VEGF), and CD31. In vitro, the expressions of Y2R, VEGF, and CD31 were detected by immunofluorescence staining in aortic endothelial cells incubated with PBS, 100μM METH, 10nmol NPY, or 100μM METH plus 10nmol NPY for 12 hours.

RESULTS

The CD31 positive area, percentage of IPH, VP, and the expressions of NPY and VEGF were significantly increased in the M8 group than in the NS group. In vitro, the expressions of Y2R, VEGF, and CD31 were significantly increased in the METH+NPY group than in the PBS, METH, and NPY groups and these effects could be blunted by treatment with a Y2R antagonist or DPPIV inhibitor.

CONCLUSION

Chronic METH administration could aggravate VP in ApoE-/- mice fed with a high-cholesterol diet, possibly through upregulating vascular NPY and VEGF expression and promoting angiogenesis and vessel rupture in atherosclerotic plaques. Our findings indicated that increased VP formation might contribute to the development of acute coronary syndrome post-chronic METH abuse by activating DPPIV/NPY/Y2R pathway.

A chemical structure and machine learning approach to assess the potential bioactivity of endogenous metabolites and their association with early-childhood hs-CRP levels

Metabolomics has gained much attraction due to its potential to reveal molecular disease mechanisms and present viable biomarkers. In this work we used a panel of untargeted serum metabolomes in 602 childhood patients of the COPSAC2010 mother-child cohort. The annotated part of the metabolome consists of 493 chemical compounds curated using automated procedures. Using predicted quantitative-structure-bioactivity relationships for the Tox21 database on nuclear receptors and stress response in cell lines, we created a filtering method for the vast number of quantified metabolites. The metabolites measured in children's serums used here have predicted potential against the chosen target modelled targets. The targets from Tox21 have been used with quantitative structure-activity relationships (QSARs) and were trained for ~7000 structures, saved as models, and then applied to 493 metabolites to predict their potential bioactivities. The models were selected based on strict accuracy criteria surpassing random effects. After application, 52 metabolites showed potential bioactivity based on structural similarity with known active compounds from the Tox21 set. The filtered compounds were subsequently used and weighted by their bioactive potential to show an association with early childhood hs-CRP levels at six months in a linear model supporting a physiological adverse effect on systemic low-grade inflammation. The significant metabolites were reported.

Interactive effect of increased high sensitive C-reactive protein and dyslipidemia on cardiovascular diseases: a 12-year prospective cohort study

BACKGROUND

Dyslipidemia and inflammation are significant factors for the onset of cardiovascular diseases (CVD); however, studies regarding their interactions on the risk of CVD are scarce. This study aimed to assess the interaction of dyslipidemia and high-sensitivity C-reactive protein (hs-CRP) on CVD.

METHODS

This prospective cohort enrolled 4,128 adults at baseline in 2009 and followed them up until May 2022 for collecting CVD events. Cox-proportional hazard regression analysis estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) of the associations of increased hs-CRP (≥ 1 mg/L) and dyslipidemia with CVD. The additive interactions were explored using the relative excess risk of interaction (RERI) and the multiplicative interactions were assessed with HRs (95% CI) while the multiplicative interactions were assessed by the HRs (95% CI) of interaction terms.

RESULTS

The HRs of the association between increased hs-CRP and CVD were 1.42 (95% CI: 1.14-1.79) and 1.17 (95% CI: 0.89-1.53) among subjects with normal lipid levels and subjects with dyslipidemia, respectively. Stratified analyses by hs-CRP levels showed that among participants with normal hs-CRP (< 1 mg/L), TC ≥ 240 mg/dL, LDL-C ≥ 160 mg/dL, non-HDL-C ≥ 190 mg/dL, ApoB < 0.7 g/L, and LDL/HDL-C ≥ 2.02 were associated with CVD [HRs (95%CIs): 1.75 (1.21-2.54), 2.16 (1.37-3.41), 1.95 (1.29-2.97), 1.37 (1.01-1.67), and 1.30 (1.00-1.69), all P < 0.05, respectively]. While in the population with increased hs-CRP, only ApoAI > 2.10 g/L had a significant association with CVD [HR (95% CI): 1.69 (1.14-2.51)]. Interaction analyses showed that increased hs-CRP had multiplicative and additive interactions with LDL-C ≥ 160 mg/dL and non-HDL-C ≥ 190 mg/dL on the risk of CVD [HRs (95%CIs): 0.309 (0.153-0.621), and 0.505 (0.295-0.866); RERIs (95%CIs): -1.704 (-3.430-0.021 and - 0.694 (-1.476-0.089), respectively, all P < 0.05].

CONCLUSION

Overall our findings indicate negative interactions between abnormal blood lipid levels and hs-CRP on the risk of CVD. Further large-scale cohort studies with trajectories measurement of lipids and hs-CRP might verify our results as well explore the biological mechanism behind that interaction.

Cardiac Dysautonomia, Decreased Baroreflex Sensitivity and Increased Myocardial Workload in Patients with Chronic Spontaneous Urticaria: A Preliminary Report

Background

Chronic stress, a potential risk factor for cardiac autonomic dysfunction and cardiovascular (CV) risk, is known to induce the onset and exacerbation of chronic spontaneous urticaria (CSU), a psychodermatological disorder. However, data regarding CV risks due to the stress associated with CSU are very limited.

Aims and Objectives

This study aimed at comparing the cardiac sympathovagal balance (SVB), inflammatory markers, perceived stress and quality of sleep in patients with CSU (test group) and normal subjects (control group). In addition, it also aimed at assessing the correlation between the SVB and other study parameters in individuals with CSU.

Materials and Methods

Thirty-four patients with CSU and twenty-eight age- and gender-matched healthy controls were recruited for the study. Heart rate variability (HRV), baroreflex sensitivity (BRS) and biochemical markers of stress and inflammation (s-cortisol, interleukin (IL)-6, IL-18 and high sensitivity C-reactive protein (hs-CRP)) were assessed following standard procedures. Perceived stress and sleep quality were assessed using pre-validated questionnaires. Study parameters were compared between the test and control groups using the independent-samples Student's t-test or Mann-Whitney U-test. The correlation between SVB and other study parameters was assessed using Spearman's rank correlation coefficient test. P < 0.05 was considered statistically significant.

Results

Levels of perceived stress, inflammatory markers, mean arterial pressure (MAP), myocardial workload (rate pressure product (RPP)), and HRV indices indicative of cardiac sympathetic activity were significantly high in individuals with CSU. In contrast, BRS and HRV indices indicative of parasympathetic activity and sleep quality were significantly low in these individuals. There was no significant correlation between SVB and other study parameters.

Conclusions

Patients with CSU have cardiac dysautonomia characterised by increased sympathetic activity and decreased parasympathetic activity. Also, the reduced BRS and increased RPP point towards an increased risk of CV morbidity in these individuals.

Examining Between-Group Differences in Social Network Density and High-Sensitivity C-Reactive Protein in Older Adults: Implications for the Hispanic Mortality Paradox

OBJECTIVE

Hispanic/Latino(x) and African American/Black older adults experience disproportionate cardiometabolic disease burdens when compared with their non-Hispanic White counterparts. Sources of resilience such as social networks have been found to mitigate the risk of this disease and its end points like high-sensitivity C-reactive protein (hs-CRP). However, little is known about the social network infrastructure among these groups. Moreover, existing work has largely ignored the degree to which members of one's network are connected to one another (network density), which may be important for navigating structural barriers within interdependent groups. The objective of this study was to understand the association between network density and 5-year hs-CRP (blood spot) and whether this association was moderated by race-ethnicity.

METHODS

A subsample of Hispanic/Latino(x), African American/Black, and non-Hispanic White older adults ( N = 1431) from the National Social Life Health and Aging Project was used. Multivariable regression was used to estimate the association between network density and its interaction with race-ethnicity, with hs-CRP 5 years later.

RESULTS

Although no main effect of network density on 5-year hs-CRP was found, results revealed a significant network density by race-ethnicity interaction (Wald χ2 (2, 1242) = 3.31, p = .037). Simple slopes analyses revealed that Hispanic/Latino(x) older adults with high network density had significantly lower hs-CRP levels when compared with their same-ethnic counterparts with low network density ( b = -0.73, standard error = 0.31, 95% confidence interval = -1.33 to -0.13, p = .018).

CONCLUSIONS

Results demonstrate population-level differences in social network structure and differential associations of this infrastructure with health. Implications for the Hispanic Mortality Paradox are discussed.

C-reactive Protein as a Predictor of Severity in Chronic Obstructive Pulmonary Disease: An Experience From a Tertiary Care Hospital

Background

In this study, we aimed to determine the frequency of raised C-reactive protein (CRP) levels and their association with the severity of the disease.

Methodology

This descriptive cross-sectional study was conducted at the Shifa International Hospital, Islamabad, from June 2018 to December 2018 in the Department of Medicine. Patients attending the respiratory outpatient clinic in the Department of Medicine, Shifa International Hospital, Islamabad, with chronic obstructive pulmonary disease, meeting the sample selection criteria, were included in our study. A total of 104 patients were enrolled. All patients had plasma CRP levels measured, and forced expiratory volume in one second to forced vital capacity ratio was calculated to quantify the severity of the disease. We used SPSS version 26.0 (IBM Corp., Armonk, NY, USA) for data analysis.

Results

All patients with levels of hs-CRP greater than 3 mg/L had stage 3 or 4 chronic obstructive pulmonary disease (COPD) according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, which accounted for 16.4% of the sample, while 81.7% of all patients suffering from COPD had levels greater than 1 mg/L. Only a small minority of patients, 1.9%, had normal high-sensitivity (hs)-CRP levels. The relationship between high levels of hs-CRP levels and advanced stages of COPD was statistically significant (p < 0.001).

Conclusions

The severity of COPD is directly related to the raised CRP levels, which can help in identifying these patients and managing them subsequently. It can be a useful indicator and a basis for high suspicion index and close follow-up for patients with high levels.

Psoriatic arthritis: interaction between cardiometabolic diseases and inflammatory burden of the disease

BACKGROUND AND OBJETIVES

Psoriatic arthritis is accompained by several cardiometabolic comorbidities. Obesity causes a low-grade systemic inflammation and is a negative predictor of treatment response. We wanted to evaluate if there are interactions between metabolic status, inflammatory parameters and disease activity; and whether metabolic or cardiovascular diseases have any association with the reduction of the inflammatory burden by treating the psoriatic arthritis.

MATERIAL AND METHODS

We have carried out a cross-sectional descriptive study of 160 patients with psoriatic arthritis. Sociodemographic, clinical and analytical variables were collected, as well as the presence of dactylitis and enthesitis; and HAQ, DAPSA and Minimal Disease Activity criteria. Chi-square test and the H of Kruskall Wallis were used to carry out comparisons, considering P < .05 as statistically significant. To establish correlations, Pearson correlation coefficient was used.

RESULTS

BMI and waist circumference correlate with CRP and ESR (significance: < .05) although the correlation strenght is low (Pearson <.4), but there is no such relationship with DAPSA or meeting MDA criteria. Using biologic therapies is associated with a lower prevalence of cardiovascular events (P = 0.047; OR: 0.12, 95% CI: 0.01-0.9) and enthesitis (P = .008; OR: 0.3, CI 95%: 0.16-0.56); and normal levels of CRP (P = .029; OR: 0.25, 95% CI: 0.07-0.87) and ESR (P = 0.024; OR: 0.36, 95% CI: 0.16-0.82) when comparing to conventional therapies.

DISCUSSION AND CONCLUSIONS

Anti-TNFα treatment could reduce cardiovascular risk in patients with psoriatic arthritis. There may be higher levels of CRP and ESR in obese individuals without this necessarily implying higher disease activity.

Significant Decrease in Glycated Hemoglobin, 2h-Post-Load Glucose and High-Sensitivity C-Reactive Protein Levels in Patients with Abnormal Body Mass Index after Therapy with Manual Lymphatic Drainage

The objective of this study was to investigate the effect of manual lymphatic drainage (MLD) on the insulin resistance parameter (HOMA-IR), glycated hemoglobin (HbA1c), C-peptide, insulin, fasting plasma glucose (FPG), 2h-post-loadglucose (2h-PG) and the concentration of high-sensitivity C-reactive protein (hsCRP) in patients with abnormal body mass index. The study involved 30 patients, including patients with normal body weight (as a control group; group I; n = 14), overweight patients (group II; n = 9) and obese patients (group III; n = 7). Each patient underwent 10 sessions of MLD therapy, 3 times a week for 30 min. In addition, we measured body mass index (BMI) and waist-to-hip ratio (WHR) and performed body composition analysis as well as biochemical tests before MLD therapy (stage 0′) and after MLD therapy (stage 1′). A statistically significant correlation was demonstrated between the concentration of C-peptide, BMI, the amount of visceral adipose tissue (r = 0.87, p = 0.003; r = 0.76, p = 0.003, respectively), and the HOMA-IR index, BMI and the amount of visceral adipose tissue (r = 0.86, p = 0.005; r = 0.84, p = 0.042, respectively), before and after MLD therapy. In overweight patients (group II), a statistically significant (p = 0.041) decrease in the hsCRP level by 2.9 mg/L and a significant (p = 0.050) decrease in the 2h-PG level by 12 mg/dL after the MLD therapy was detected. Moreover, in the group of obese patients (group III), a statistically significant (p = 0.013) decrease in HbA1c level by 0.2% after MLD therapy was demonstrated. Our results indicate that MLD may have a positive effect on selected biochemical parameters, with the most favorable changes in overweight patients. Further studies in a larger number of patients are warranted to confirm our findings, to test in-depth their mechanism, and to investigate clinical benefits of this alternative therapy in patients with abnormal body mass index.

The role of inflammation and the possibilities of inflammation reduction to prevent cardiovascular events

Chronic systemic inflammation is a risk factor for cardiovascular (CV) disease (CVD). Whether this relationship extends to subclinical inflammation, quantified by values of circulating markers associated with inflammation in the high range of the normal interval, remains debatable. This narrative review evaluates evidence exploring this relationship. A review of pharmacological and non-pharmacological interventions, including diet and lifestyle strategies, supplements, nutraceuticals, and other natural substances aimed at reducing inflammation was also conducted, since few reviews have synthesized this literature. PubMed and EMBASE were used to search the literature and several well-studied triggers of inflammation [oxidized LDL, Lp(a), as well as C-reactive protein (CRP)/high-sensitivity CRP (hs-CRP)] were included to increase sensitivity and address the lack of existing reviews summarizing their influence in the context of inflammation. All resulting references were assessed. Overall, there is good data supporting associations between circulating hs-CRP and CV outcomes. However, the same was not seen in studies evaluating triggers of inflammation, such as oxidized LDL or Lp(a). There is also insufficient evidence showing treatments to target inflammation and lead to reductions in hs-CRP result in improvements in CV outcomes, particularly in those with normal baseline levels of hs-CRP. Regarding pharmacological interventions, statins, bempedoic acid, and apabetalone significantly reduce circulating hs-CRP, unlike PCSK-9 inhibitors. A variety of natural substances and vitamins were also evaluated and none reduced hs-CRP. Regarding non-pharmacological interventions, weight loss was strongly associated with reductions in circulating hs-CRP, whereas various dietary interventions and exercise regimens were not, unless accompanied by weight loss.

C-reactive protein and telomerase reverse transcriptase (TERT) associate with chronic disease markers in a sample from low-income neighborhoods in Detroit, Michigan

Racial and ethnic minorities in economically deprived inner cities experience high rates of chronic diseases compared to neighborhoods with higher socioeconomic status (SES). However, these economically deprived populations are understudied in terms of biomarkers associated with chronic disease risk which include C-reactive protein (CRP), telomerase reverse transcriptase (TERT), and glycosylated hemoglobin (A1C). We examined relationships between CRP and TERT and chronic disease indicators (body mass index [BMI] and A1C) in two low-income, predominantly African American (AA) neighborhoods in Detroit, Michigan. Sixty-nine adults (43 females, 26 males, mean age 46 years [y], standard deviation [SD] ​= ​15.9) completed a health survey, anthropometry, and finger stick blood tests. A1C was measured using A1CNow test strips, and CRP and TERT levels were measured using enzyme-linked immunosorbent assay (ELISA) with samples extracted from dried blood spots. We examined CRP (mean ​= ​4.9, SD ​= ​3.1), TERT (mean ​= ​32.5, SD ​= ​15.1), and A1C (mean ​= ​5.4, SD ​= ​1.0) by BMI category. We fitted restricted maximum likelihood regression models to evaluate associations between CRP, TERT, BMI, and A1C, after adjustment for demographics and inclusion of a random effect for the neighborhood. In this predominantly AA sample (91%, 63/69), 68% had levels of CRP (means ​= ​4.8 ​mg/L, SD ​= ​3.0 for AAs; 6.4 ​mg/L, SD ​= ​3.9 for all others) indicative of chronic inflammation (CRP greater than 3 ​mg/L). BMI was significantly associated with CRP (p ​= ​0.004) and TERT (p ​= ​0.026). TERT levels indicate that being overweight is associated with markers of chromosome remodeling, suggestive of chronic disease. CRP followed a similar trend with overweight individuals having higher inflammation and risk of chronic disease. Our findings warrant further exploration of additional factors that may influence CRP and TERT. Furthermore, examining populations in a more ethnically and/or economically diverse, yet still high proportion minority, sample will fill a knowledge gap in this understudied field.

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Pandemic: Are Africa's Prevalence and Mortality Rates Relatively Low?

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the cause of coronavirus disease 19 (COVID-19), has been rapidly spreading since December 2019, and within a few months, it turned out to be a global pandemic. The disease affects primarily the lungs, but its pathogenesis spreads to other organs as well. However, its mortality rates vary, and in the majority of infected people, there are no serious consequences. Many factors including advanced age, preexisting health conditions, and genetic predispositions are believed to exacerbate outcomes of COVID-19. The virus contains several structural proteins including the spike (S) protein with subunits for binding, fusion, and internalization into host cells following interaction with host cell receptors and proteases (ACE2 and TMPRSS2, respectively) to cause the subsequent pathology. Although the pandemic has spread into all countries, most of Africa is thought of as having relatively less prevalence and mortality. Several hypotheses have been forwarded as reasons for this and include warmer weather conditions, vaccination with BCG (i.e., trained immunity), and previous malaria infection. From genetics or metabolic points of view, it has been proposed that most African populations could be protected to some degree because they lack some genetic susceptibility risk factors or have low-level expression of allelic variants, such as ACE2 and TMPRSS2 that are thought to be involved in increased infection risk or disease severity. The frequency of occurrence of α-1 antitrypsin (an inhibitor of a tissue-degrading protease, thereby protecting target host tissues including the lung) deficiency is also reported to be low in most African populations. More recently, infections in Africa appear to be on the rise. In general, there are few studies on the epidemiology and pathogenesis of the disease in African contexts, and the overall costs and human life losses due to the pandemic in Africa will be determined by all factors and conditions interacting in complex ways.

Long-term prognosis of patients with stroke associated with middle cerebral artery occlusion. Single-centre registration study

INTRODUCTION

Large artery intracranial occlusive disease including middle cerebral artery (MCA) is a major contributor to the incidence of stroke in China. The data on the prognosis of symptomatic atherosclerotic MCA occlusions (MCAO) are limited. We aimed to investigate the related factors of unfavorable outcomes in patients with stroke associated with MCAO.

MATERIAL AND METHODS

A total of 119 patients with MCAO symptom were enrolled in this retrospective longitudinal cohort study. All patients met inclusion criteria of cerebral angiography by CT angiography or magnetic resonance angiography. Stroke severity was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).

RESULTS

We showed an average follow-up time of 46.8 months, within which 20 (19.6%) cases died and 14 (13.7%) cases had stroke recurrence. Using mRS as an evaluation index, the patients were divided into an unfavourable outcome group (mRS > 2, 48 cases) and a favourable outcome group (mRS ≤ 2, 54 cases). Logistic regression analysis suggests that age and NIHSS score were independent risk factors for a poor outcome value. Coexisting other cerebral vascular occlusion was an independent risk factor for stroke recurrence. Age was an independent risk factor for death.

CONCLUSIONS

The prognosis of patients with MCAO was generally optimistic, with higher survival rate and longer survival time. As compared, elder age and higher NIHSS score both tend to be associated with worse prognosis of survival. MCAO patients with other extracranial or intracranial vascular occlusion have higher risk of recurrent stroke. Death rate increases with age among the MCAO patients.

Associations of 25 Hydroxyvitamin D and High Sensitivity C-reactive Protein Levels in Early Life

Vitamin D deficiency and elevated high sensitivity C-reactive protein (hs-CRP) have been associated with several health outcomes, but knowledge on early life trajectories and association between 25 hydroxyvitamin D (25(OH)D) and hs-CRP is lacking. We investigated the association between longitudinal measurements of 25(OH)D and hs-CRP, respectively, from pregnancy to childhood and throughout childhood in two Danish mother–child cohorts—the COPSAC₂₀₁₀ and COPSAC₂₀₀₀. In COPSAC₂₀₁₀, there was an association between 25(OH)D concentrations at week 24 in pregnancy and at age 6 months in childhood (n = 633): estimate (95% CI); 0.114 (0.041;0.187), p = 0.002, and between 25(OH)D at age 6 months and 6 years (n = 475): 0.155 (0.083;0.228), p < 0.001. This was also demonstrated in the COPSAC₂₀₀₀ cohort between 25(OH)D concentrations in cord blood and at age 4 years (n = 188): 0.294 (0.127;0.461), p < 0.001 and at age 6 months and 4 years (n = 264): 0.260 (0.133;0.388), p < 0.001. In COPSAC₂₀₀₀, we also found an association between hs-CRP at age 6 months and 12 years in childhood (n = 232): 0.183 (0.076;0.289), p < 0.001. Finally, we found a negative association between the cross-sectional measurements of 25(OH)D and hs-CRP at age 6 months (n = 613) in COPSAC₂₀₁₀: −0.004 (−0.008;−0.0004), p = 0.030, but this was not replicated in COPSAC₂₀₀₀. In this study, we found evidence of associations across timepoints of 25(OH)D concentrations from mid-pregnancy to infancy and through childhood and associations between hs-CRP levels during childhood, although with weak correlations. We also found a negative cross-sectional association between 25(OH)D and hs-CRP concentrations in COPSAC₂₀₁₀ proposing a role of vitamin D in systemic low-grade inflammation, though this association was not present in COPSAC₂₀₀₀.

BMI metrics and their association with adiposity, cardiometabolic risk factors, and biomarkers in children and adolescents

BACKGROUND

There are limited data comparing the relative associations of various BMI metrics with adiposity and cardiometabolic risk factors in youth.

OBJECTIVE

Examine correlations of 7 different BMI metrics with adiposity, cardiometabolic risk factors, and biomarkers (i.e. blood pressure, waist circumference, cholesterol, leptin, insulin, high molecular weight adiponectin, high-sensitivity c-reactive protein (hsCRP)).

METHODS

This was a cross-sectional analysis of youth in all BMI categories. BMI metrics: BMI z-score (BMIz), extended BMIz (ext.BMIz), BMI percentile (BMIp), percent of the BMI 95th percentile (%BMI_p95), percent of the BMI median (%BMI_p50), triponderal mass index (TMI), and BMI (BMI). Correlations between these BMI metrics and adiposity, visceral adiposity, cardiometabolic risk factors and biomarkers were summarized using Pearson's correlations.

RESULTS

Data from 371 children and adolescents ages 8-21 years old were included in our analysis: 52% were female; 20.2% with Class I obesity, 20.5% with Class II, and 14.3% with Class III obesity. BMIp consistently demonstrated lower correlations with adiposity, risk factors, and biomarkers (r = 0.190-0.768) than other BMI metrics. The %BMI_p95 and %BMI_p50 were marginally more strongly correlated with measures of adiposity as compared to other BMI metrics. The ext.BMIz did not meaningfully outperform BMIz.

CONCLUSION

Out of all the BMI metrics evaluated, %BMI_p95 and %BMI_p50 were the most strongly correlated with measures of adiposity. %BMI_p95 has the benefit of being used currently to define obesity and severe obesity in both clinical and research settings. BMIp consistently had the lowest correlations. Future research should evaluate the longitudinal stability of various BMI metrics and their relative associations with medium to long-term changes in adiposity and cardiometabolic outcomes in the context of intervention trials.

Central obesity is a contributor to systemic inflammation and monocyte activation in virally suppressed adults with chronic HIV in Kenya

OBJECTIVES

Heightened systemic inflammation is common in obese individuals and persons with HIV (PWH) and is independently associated with an increased risk of cardiovascular diseases (CVDs). We investigated the combined effect of central obesity, a surrogate measure of visceral fat and HIV on circulating levels of inflammatory cytokines among Kenyan adults.

DESIGN

A cross-sectional study.

METHODS

We analysed and compared data from 287 virally suppressed PWH and 277 noninfected Kenyan adults, including biomarkers of gut epithelial dysfunction (intestinal fatty acid binding protein), monocyte activation (soluble CD163 and CD14) and inflammation [interleukin (IL)-1β, IL-6, TNF-α and hsCRP] by HIV/central obesity status (HIV-positive/obese, HIV-negative/obese, HIV-positive/nonobese and HIV-negative/nonobese). Central obesity was defined as waist circumference more than 80 cm for women and more than 94 cm for men. We assessed the association of HIV/obesity status with elevated biomarkers (>75th percentile) using logistic regression.

RESULTS

Median age for participants was 44 years and 37% were centrally obese. Levels of all biomarkers were higher among the HIV-positive/obese compared with the HIV-negative/nonobese (P < 0.05 for all comparisons). The HIV-positive/obese group had the greatest odds of having elevated inflammatory biomarkers compared with other groups even after adjustment of age, BMI and other conventional CVD risk factors (P < 0.05 for all). Additional adjustment for sCD163 in the multivariate model substantially attenuated the association for HIV-positive/obesity with IL-1β, IL-6 and TNF-α but not hsCRP. The contribution of HIV-positive/obesity to inflammation was independent of the degree of immunosuppression.

CONCLUSION

Central obesity is prevalent among virally suppressed African PWH and is associated with greater inflammation and monocyte activation independent of other comorbidities and HIV-specific factors.

The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies

AIMS

Children with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint.

DATA SYNTHESIS

A literature search was performed in PubMed and Web of Science. Studies were selected if they included participants aged <18 years with obesity and presented data before and after weight loss and after weight regain hereby reporting minimally 1 cardiovascular risk factor at every assessment. After screening, nine articles remained. Generally, the diastolic BP re-increased after weight regain, whereas for systolic BP a sustained result for 6 months was reported with an increase during longer follow-up. No significant changes in fasting glucose were reported after weight regain compared to baseline. Regarding triglycerides, a complete weight regain re-increased the lowered values to baseline, whereas a partial regain resulted in a sustained decrease in triglycerides in 2 studies and an increase to intermediate levels in 1 paper. HDL-cholesterol only rose several months after initiating treatment. Hs-CRP remained lowered for a longer period than the moment where the weight loss nadir was achieved.

CONCLUSION

Research on weight regain and cardiometabolic health in children with obesity is scarce. No convincing evidence was found for a worsening of the cardiometabolic profile after weight regain. Some benefits even persisted despite weight recovery. Subsequently, the metabolic syndrome prevalence seems temporarily lowered after weight loss, despite weight regain.

Prognostic Value of Cardiovascular Testing in Asymptomatic Patients With a History of Cardiovascular Disease: A Review of Contemporary Medical Literature

The cardiac stress testing, carotid duplex, coronary artery calcium (CAC) scoring, myocardial perfusion imaging, coronary angiography, C-reactive protein (CRP), glycated hemoglobin (HbA1C), total serum cholesterol, duplex ultrasonography, digital subtraction angiography, magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography, and ankle-brachial index (ABI) independently predict the risks and prognostic outcomes in asymptomatic cardiovascular disease (CVD) patients. The peripheral artery disease (PAD) screening guides the diagnosis, management, and prognosis of hemodynamically significant arterial stenosis, calcification, and malignant hypertension in patients with CVD without symptoms. The 79% sensitivity and 96% specificity of ABI screening, 90% sensitivity and 97% specificity of MRA, and 95% sensitivity and 50% specificity of CTA for tracking arterial occlusion indicate the high prognostic value of these tests in the setting of CVD. The 85% specificity and 60-70% sensitivity of cardiac stress testing substantiate its suitability to determine asymptomatic CVD prognosis related to myocardial ischemia, heart failure, multivessel disease, and unstable angina. The carotid duplex ultrasound potentially identifies long-term mortality, stroke, atherosclerosis, plaque instability, and angiographic stenosis among asymptomatic CVD patients with 94% specificity and 90% sensitivity. The CAC scoring has a positive predictive value (PPV) of 45.7% for identifying aortic valve calcium and PPV of 79.3% for tracking thoracic artery calcium. The medical literature provides substantial evidence concerning the validity, reliability, and prognostic value of cardiovascular testing for asymptomatic patients. Future studies are needed to undertake detailed assessments of benefits versus adverse outcomes associated with the prospective scaling (of cardiovascular testing) across asymptomatic CVD patients.

Analysis of the association and predictive value of hyperhomocysteinaemia for obstructive coronary artery disease

Objective

To investigate the predictive value of hyperhomocysteinaemia (HHcy) for obstructive coronary artery disease (CAD) in an Asian population in northern China.

Methods

This retrospective study enrolled patients at their first cardiac assessment and assigned them to an obstructive CAD group or a non-obstructive CAD group according to the coronary angiography results. HHcy was defined as a homocysteine (Hcy) level > 15 µmol/l.

Results

This study enrolled 2987 participants: 1172 in the non-obstructive CAD group and 1815 in the obstructive CAD group. Hcy level in the obstructive CAD group was significantly higher than in the non-obstructive CAD group. The proportion of patients with HHcy in the obstructive CAD group was significantly greater than in the non-obstructive CAD group. Multivariate logistic regression analysis demonstrated that HHcy was independently correlated with obstructive CAD in both young (aged ≤ 55 years) and old patients (aged > 55 years). HHcy showed a higher sensitivity (93.1%), specificity (86.1%) and accuracy (90.0%) for obstructive CAD. The odds ratio for HHcy was 84.2. The Kappa value (0.8) showed substantial agreement between obstructive CAD and HHcy.

Conclusions

HHcy was associated with obstructive CAD and may be a potentially independent risk factor for obstructive CAD with good predictive value.

Psoriatic arthritis: interaction between cardiometabolic diseases and inflammatory burden of the disease

BACKGROUND AND OBJETIVES

Psoriatic arthritis is accompained by several cardiometabolic comorbidities. Obesity causes a low-grade systemic inflammation and is a negative predictor of treatment response. We wanted to evaluate if there are interactions between metabolic status, inflammatory parameters and disease activity; and whether metabolic or cardiovascular diseases have any association with the reduction of the inflammatory burden by treating the psoriatic arthritis.

MATERIAL AND METHODS

We have carried out a cross-sectional descriptive study of 160 patients with psoriatic arthritis. Sociodemographic, clinical and analytical variables were collected, as well as the presence of dactylitis and enthesitis; and HAQ, DAPSA and Minimal Disease Activity criteria. Chi-square test and the H of Kruskall Wallis were used to carry out comparisons, considering P<.05 as statistically significant. To establish correlations, Pearson correlation coefficient was used.

RESULTS

BMI and waist circumference correlate with CRP and ESR (significance: <.05) although the correlation strenght is low (Pearson<.4), but there is no such relationship with DAPSA or meeting MDA criteria. Using biologic therapies is associated with a lower prevalence of cardiovascular events (P=0.047; OR: 0.12, 95% CI: 0.01-0.9) and enthesitis (P=.008; OR: 0.3, CI 95%: 0.16-0.56); and normal levels of CRP (P=.029; OR: 0.25, 95% CI: 0.07-0.87) and ESR (P=0.024; OR: 0.36, 95% CI: 0.16-0.82) when comparing to conventional therapies.

DISCUSSION AND CONCLUSIONS

Anti-TNFα treatment could reduce cardiovascular risk in patients with psoriatic arthritis. There may be higher levels of CRP and ESR in obese individuals without this necessarily implying higher disease activity.

Unraveling the Complexity of HDL Remodeling: On the Hunt to Restore HDL Quality

Increasing evidence has cast doubt over the HDL-cholesterol hypothesis. The complexity of the HDL particle and its proven susceptibility to remodel has paved the way for intense molecular investigation. This state-of-the-art review discusses the molecular changes in HDL particles that help to explain the failure of large clinical trials intending to interfere with HDL metabolism, and details the chemical modifications and compositional changes in HDL-forming components, as well as miRNA cargo, that render HDL particles ineffective. Finally, the paper discusses the challenges that need to be overcome to shed a light of hope on HDL-targeted approaches.

Gender Difference in the Relationships between Inflammatory Markers, Serum Uric Acid and Framingham Risk Score

The purpose of the present study was to explore the role of gender in the relation of high-sensitivity C-reactive protein (hsCRP), white blood cell (WBC) count, and serum uric acid (UA) to the risk of future cardiovascular disease (CVD) events. In total, 404 workers were recruited to obtain the measurements of serum markers for CVD risk. Demographic data, nutrition, exercise, smoking, and alcohol consumption were assessed through a questionnaire. The Framingham Risk Score (FRS) was adopted to estimate the risk of future CVD events. Multiple linear regression models were used to determine CVD risk markers in relation to the FRS by gender. The hsCRP was not significantly correlated with the FRS for all workers after adjusting for covariates, including demographic data and health-related lifestyle. WBC count was positively correlated with FRS for all workers, but WBC count did not show an interaction with gender with respect to the FRS. Serum UA showed an interaction with gender on the FRS, and UA positively correlated with the FRS in males though not in females. With respect to CVD prevention, the WBC count can be used to monitor the risk for all workers. Due to a gender difference shown in the relationship between serum UA and the FRS, serum UA can be a monitor of the risk of future CVD events in male workers only.

Combined Oral Contraceptive Pill-Induced Hypertension and Hypertensive Disorders of Pregnancy: Shared Mechanisms and Clinical Similarities

PURPOSE OF REVIEW

Oral contraceptive pill-induced hypertension (OCPIH) and hypertensive disorders in pregnancy (HDP) share common risk factors and pathophysiological mechanisms, yet the bidirectional relationship between these two conditions is not well-established. We review and describe OCPIH and HDP to better understand how hormonal and metabolic imbalances affect hypertension.

RECENT FINDINGS

Oral contraceptive pills continue to be a popular method of contraception, with an incidence of OCPIH ranging from 1-8.5% among OCP users. HDP have an incidence of 5-10% of all pregnancies in the USA and have been shown to be a powerful predictor of lifetime adverse cardiovascular outcomes, including future hypertension. OCPIH and HDP share common risk factors such as age, BMI, past personal and family history of hypertension, as well as pathogenic mechanisms, including alterations in hormonal metabolism and the renin angiotensin aldosterone system; imbalance of vasodilator-vasoconstrictor compounds; and changes in the cardiovascular system. Future research should address additional potential mechanisms that underlie hypertension in these two conditions where endocrine changes, either physiological (pregnancy) or iatrogenic (use of OCP), play a role. This may lead to novel, targeted treatment options to improve hypertension management and overall cardiovascular risk profile management in this subset of young female patients.

Association between serum level of C-reactive protein and risk of cardiovascular events based on cohort studies

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.

Adequate intake of plant protein foods and moderate intake of animal protein foods are inversely associated with C-reactive protein in US adults with diabetes: A cross-sectional study with National Health and Nutrition Examination Survey

OBJECTIVE

This study examined the association between index component score levels of the Dietary Approaches to Stop Hypertension (DASH) density-based index and the Healthy Eating Index-2015 (HEI-2015) for protein foods and a high-sensitivity C-reactive protein (hs-CRP) level in US adults with diabetes status.

METHODS

This cross-sectional study used data from adult participants (≥20 y) in the National Health and Nutrition Examination Survey 2005-2010 (n = 12070) to obtain hs-CRP levels and index scores in US adults. Odds ratios (OR) of having an elevated hs-CRP (>3.0 mg/L) by score levels of protein food components (low: <80% versus high: ≥80% of the maximum score) were acquired using survey multivariable logistic regression analysis.

RESULTS

After adjusting for age group, sex, race/ethnicity, and other potential confounders, participants with a low score were more likely to have an elevated hs-CRP level than those with a high score (DASH plant proteins and HEI-2015 seafood and plant proteins: P < 0.001). Adults with diabetes who had a low score were more likely to have an elevated hs-CRP than adults without diabetes who had a high score (DASH animal proteins: OR 1.53, 95% confidence interval [CI] 1.24-1.87) (DASH plant proteins: OR 1.51, 95% CI 1.22-1.87) (HEI-2015 seafood and plant proteins: OR 1.38, 95% CI 1.16-1.65). Among adults with diabetes, those with a low score for animal protein foods were more likely to have an elevated hs-CRP (DASH animal proteins: OR 1.42, 95% CI 1.11-1.82) than those with a high score.

CONCLUSIONS

Moderate intake of animal protein foods and adequate intake of plant protein foods were inversely associated with an elevated hs-CRP level in US adults, especially in those with diabetes. Further investigation is required to establish ideal density-based amounts or proportions of protein food subgroups.

Nanodiagnostic Attainments and Clinical Perspectives on C-Reactive Protein: Cardiovascular Disease Risks Assessment

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.

The impact of methotrexate therapy with vitamin D supplementation on the cardiovascular risk factors among patients with psoriasis; a prospective randomized comparative study

BACKGROUND

Controlling psoriasis with various systemic treatments, including methotrexate, may significantly decrease associated cardiovascular risk problems.

OBJECTIVE

To assess the value of vitamin D supplementation on clinical response as well as changes in cardiovascular risk parameters in psoriasis patients treated with methotrexate.

METHODS

This prospective randomized comparative study included 30 patients with moderate to severe psoriasis divided randomly to receive either methotrexate alone (Mtx) or methotrexate plus intramuscular vitamin D (MtxD) for 3 months. Lipid profile, HsCRP, carotid intima-media thickness (CIMT) and blood pressure (BP) measurements were recorded before and after the therapy.

RESULTS

At end of study period, significant clinical improvement in both groups was observed. CIMT and systolic BP decreased in both groups but only statistically significant in Mtx group. HsCRP decreased in both groups but didn't reach statistical significance. We also observed, an increase in triglycerides and cholesterol levels in the Mtx group with the latter decreasing in the combined Mtx and vitamin D therapy group.

CONCLUSION

Treating psoriasis with methotrexate may decrease cardiovascular disease risk factors. Adding vitamin D supplementation to methotrexate may protect lipid homeostasis, specifically cholesterol and triglycerides.

Agomelatine Attenuates Isoflurane-Induced Inflammation and Damage in Brain Endothelial Cells

Background and Purpose

Neurotoxicity of anesthetics has been widely observed by clinicians. It is reported that inflammation and oxidative stress are involved in the pathological process. In the present study, we aimed to assess the therapeutic effects of agomelatine against isoflurane-induced inflammation and damage to brain endothelial cells.

Materials and Methods

MTT assay was used to detect cell viability in order to determine the optimized concentration of agomelatine. The bEnd.3 brain endothelial cells were treated with 2% isoflurane in the presence or absence of agomelatine (5, 10 μM) for 24 h. LDH release was evaluated and the ROS levels were checked using DHE staining assay. The expressions of IL-6, IL-8, TNF-α, VEGF, TF, VCAM-1, and ICAM-1 were evaluated using real-time PCR and ELISA. Real-time PCR and Western blot analysis were used to determine the expression level of Egr-1.

Results

The decreased cell viability promoted LDH release and elevated ROS levels induced by isoflurane were significantly reversed by the introduction of agomelatine in a dose-dependent manner. The expression levels of IL-6, IL-8, TNF-α, VEGF, TF, VCAM-1, and ICAM-1 were elevated by stimulation with isoflurane, which were significantly suppressed by the administration of agomelatine. The up-regulation of transcriptional factor Egr-1 induced by isoflurane was down-regulated by agomelatine.

Conclusion

Agomelatine might attenuate isoflurane-induced inflammation and damage via down-regulating Egr-1 in brain endothelial cells.

Largely Accelerated Arterial Aging in Rheumatoid Arthritis Is Associated With Inflammatory Activity and Smoking in the Early Stage of the Disease

Background: Rheumatoid arthritis (RA) patients have a shorter life expectancy than the general population primarily due to cardiovascular comorbidities.

Objectives: To characterize arterial aging in RA.

Patients and Methods: Coronary calcium score (CCS) were available from 112 RA patients; out of these patients, follow-up CCS were measured for 54 randomly selected individuals. Control CCS were obtained from the MESA database (includes 6,000 < participants); arterial age was calculated from CCS.

Results: RA patients were significantly older (10.45 ± 18.45 years, p < 0.001) in terms of the arterial age than the age-, gender-, and race-matched controls. The proportion of RA patients who had zero CCS was significantly less (p < 0.01) than that of those in the MESA reference group. Each disease year contributed an extra 0.395 years (p < 0.01) on the top of the normal aging process. However, the rate of the accelerated aging is not uniform, in the first years of the disease it is apparently faster. Smoking (p < 0.05), previous cardiovascular events (p < 0.05), and high blood pressure (p < 0.05) had additional significant effect on the aging process. In the follow-up study, inflammatory disease activity (CRP > 5 mg/L, p < 0.05) especially in smokers and shorter than 10 years of disease duration (p = 0.05) had the largest impact.

Conclusion: Arterial aging is faster in RA patients than in control subjects, particularly in the first 10 years of the disease. Inflammation, previous cardiovascular events, and smoking are additional contributing factors to the intensified coronary atherosclerosis progression. These data support that optimal control of inflammation is essential to attenuate the cardiovascular risk in RA.

The Impact of hs-CRP on Cardiovascular Risk Stratification in Pilots and Air Traffic Controllers

INTRODUCTION: We assessed determinants of serum hs-CRP level in pilots and air traffic controllers (ATCs) and its impact on their atherosclerotic cardiovascular disease (ASCVD) risk.METHODS: We obtained serum hs-CRP measurements, evaluated traditional cardiovascular risk factors and assessed global ASCVD risk based on 2018 ESH/ESC guidelines. Elevated hs-CRP was hs-CRP values > 3 mg L¹. Determinants of elevated hs-CRP were assessed using stepwise logistic regression analysis. We used the net reclassification method to evaluate the impact of hs-CRP levels on global ASCVD risk.RESULTS: Of the 335 subjects (mean age 45.4 11.6 yr, 70% pilots, 99% men, 37% Caucasians), 127 individuals (39.5%) presented with elevated hs-CRP levels. Compared to those with normal hs-CRP, individuals with elevated hs-CRP were older with faster heart rate and higher blood pressure, BMI, and P wave amplitude. The proportion of individuals with elevated hs-CRP was greater among those with smoking habits, physical inactivity, MetS, tachycardia, altered P wave axis, LVH, and HT-TOD. Aging (aOR 2.15 [1.676.98]), hypertension (aOR 3.88 [2.296.58]), type 2 diabetes (aOR 6.71 [1.7710.49]), tachycardia (aOR 2.03 [1.914.53]), and LVH (aOR 2.13 [1.647.11]) were the main factors associated with elevated hs-CRP levels. Low, moderate, high, and very high risk were observed in 24 (15%), 68 (41%), 62 (37%), and 12 (7%) subjects, respectively. Including hs-CRP resulted in the net reclassification of 25% of subjects, mostly from moderate to high risk.CONCLUSION: The integration of hs-CRP improved the estimation of global ASCVD risk stratification. However, a survey with a comprehensive population assessing the cost/benefit impact of such a referral is needed.Buila NB, Ntambwe ML, Mupepe DM, Lubenga YN, Bantu J-MB, Mvunzi TS, Kabanda GK, Lepira FB, Kayembe PK, Ditu SM, MBuyamba-Kabangu J-R. The impact of hs-CRP on cardiovascular risk stratification in pilots and air traffic controllers. Aerosp Med Hum Perform. 2020; 91(11):886891.

Effect of lurasidone versus olanzapine on cardiometabolic parameters in unmedicated patients with schizophrenia: a randomized controlled trial

OBJECTIVE

Patients with schizophrenia are at higher risk of cardiovascular morbidity and mortality than healthy individuals. This study was conducted to compare the effect of lurasidone and olanzapine on cardiometabolic parameters in unmedicated patients with schizophrenia.

METHODS

The present study was a randomized open-label, parallel design, active-controlled clinical trial. After recruitment and randomization of 101 patients, a baseline assessment was done by PANSS, SOFAS, lipid profile, fasting blood glucose, HbA_1c, serum insulin and serum hs-CRP. HOMA-IR, atherogenic index, coronary risk index and cardiovascular risk indices were calculated as derived parameters. Patients received either lurasidone 80 mg or olanzapine 10 mg as monotherapy and followed up after 6 weeks.

RESULTS

There was a significant increase in fasting blood glucose (p < 0.001), HbA_1c (p < 0.001) and serum insulin (p < 0.001) after 6 weeks of therapy in both the treatment groups but the difference between the groups was not significant (FBS, p = 0.209; HbA1c, p = 0.209; serum insulin, p = 0.720). Olanzapine showed worsening of lipid profile (p < 0.001) while the same improved with lurasidone (p < 0.001) and the difference between the groups was found to be significant (p < 0.001). Serum HDL level decreased in both the treatment groups (olanzapine, p < 0.001; lurasidone, p < 0.001) but the difference between the groups was not significant (p = 0.333). There was an increase in hs-CRP levels in both the treatment groups (olanzapine, p < 0.001; lurasidone, p < 0.001) with no significant difference between them (p = 0.467). Atherogenic index, coronary risk index and cardiovascular risk index increased significantly in the olanzapine group as compared with the lurasidone group (p < 0.001).

CONCLUSION

Lurasidone showed a favourable effect on lipid profile and cardiovascular risk indices over olanzapine. However, long-term studies are needed to establish and generalize the findings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03304457.

Assessment of high sensitivity C-reactive protein and coronary plaque characteristics by computed tomography in patients with and without diabetes mellitus

Background

To evaluate the coronary plaque characteristics of coronary arteries using computed tomography angiography (CTA) in order to assess the risk of coronary artery disease and the relevance of high sensitivity C reactive protein (hs-CRP) in patients with Diabetes Mellitus (DM).

Methods

The clinical data of 400 DM patients and 400 non-DM patients from January 2017 to December 2019 were collected, including the results of coronaryCTA. The plasma hs-CRP level of the two groups were divided into three groups: CRP ≤ 1, 1 < CRP ≤ 2, CRP > 2. The correlation of the degree of stenosis, the number of plaques, the nature of plaques and hs-CRP value between the two groups was evaluated.

Results

Compared with non-DM patients, the incidence of coronary artery plaques and lumen stenosis in DM patients was more higher than that in non-DM patients. DM patients were more likely to have more diseased vessels, especially diffuse vascular disease (12.00% vs 1.75%; P < 0.001). Subjects with high hs-CRP levels were more likely to have any plaque compared with individuals showing normal hs-CRP levels (p<0.01). There was no statistical significance in non calcified plaque with high level of hs-CRP, but the occurrence of plaque types in DM group was statistically significant compared with other hs-CRP levels in non DM group. Subjects with high hs-CRP were observed to be at increased risk for the presence of calcified plaque and severe narrowing in the unadjusted values.

Conclusions

Coronary CTA combined with hs-CRP can accurately detect the characteristics of coronary artery stenosis and plaque in DM patients, which has an important clinical value in the risk assessment of coronary heart disease in DM patients.

Associations of C-reactive protein and fibrinogen with mortality from all-causes, cardiovascular disease and cancer among U.S. adults

C-reactive protein (CRP) and fibrinogen are associated with an increased risk of death with suggested differences by gender, diet quality and race/ethnicity. However, the current evidence is limited. We used data including 8646 men and 9880 women from the National Health and Nutrition Examination Survey (NHANES) Linked Morality cohort (1999-2011) to investigate the associations of CRP and fibrinogen with mortality overall and by gender, race/ethnicity and diet quality. Cox-proportional hazard model was used to quantify the associations. With a median follow-up of 6 years, a strong dose-response relationship was observed between CRP levels and mortality risk in men after multivariable adjustment. For subjects who survived the first two years, the adjusted hazard ratios (HRs) for total mortality across quartiles (from lower to higher) of CRP were 1.97 (95% CI: 0.62-6.33), 1.89 (0.59, 6.06) and 6.34 (2.28-17.7) (P for trend <0.001). For cardiovascular disease (CVD) mortality, its association with CRP varied by diet quality. For cancer mortality, its association differed by history of cancer, and positive associations were observed only among subjects with history of cancer. In contrast, no such association of CRP with mortality was found in women. For fibrinogen, we observed its positive association with total mortality and the HRs across quartiles of fibrinogen (from lower to higher) were 1.21 (0.88, 1.67), 1.49 (1.22, 1.82) and 1.99 (1.56, 2.55). The association with CVD mortality differed by diet quality whereas no association was found with cancer mortality. Our findings suggest that higher levels of CRP and fibrinogen were associated with lower survival from total and CVD; the associations of CRP with mortality were more pronounced in men than women. Diet quality is an effect modifier for the association of CRP and fibrinogen with CVD mortality.

Education, Smoking and CRP Genetics in Relation to C-Reactive Protein Concentrations in Black South Africans

Because elevated circulating C-reactive protein (CRP) and low socio-economic status (SES), have both been implicated in cardiovascular disease development, we investigated whether SES factors associate with and interact with CRP polymorphisms in relation to the phenotype. Included in the study were 1569 black South Africans for whom CRP concentrations, 12 CRP single nucleotide polymorphisms (SNPs), cardiovascular health markers, and SES factors were known. None of the investigated SES aspects was found to associate with CRP concentrations when measured individually; however, in adjusted analyses, attaining twelve or more years of formal education resulted in a hypothetically predicted 18.9% lower CRP concentration. We also present the first evidence that active smokers with a C-allele at rs3093068 are at an increased risk of presenting with elevated CRP concentrations. Apart from education level, most SES factors on their own are not associated with the elevated CRP phenotype observed in black South Africans. However, these factors may collectively with other environmental, genetic, and behavioral aspects such as smoking, contribute to the elevated inflammation levels observed in this population. The gene-smoking status interaction in relation to inflammation observed here is of interest and if replicated could be used in at-risk individuals to serve as an additional motivation to quit.

How C-Reactive Protein Structural Isoforms With Distinctive Bioactivities Affect Disease Progression

C-reactive protein (CRP) is a widely known, hepatically synthesized protein whose blood levels change rapidly and pronouncedly in response to any tissue damaging event associated with an inflammatory response. The synthesis and secretion of CRP is stimulated by interleukin-6, an early pleiotropic cytokine released by macrophages, endothelial, and other cells that are activated when localized normal tissue structures are compromised by trauma or disease. Serum CRP levels can change rapidly and robustly from 10-100-fold within 6–72 h of any tissue damaging event. Elevated blood levels correlate with the onset and extent of both activated inflammation and the acute phase biochemical response to the tissue insult. Because its functional bioactivity as the prototypic acute phase reactant has eluded clear definition for decades, diagnosticians of various conditions and diseases use CRP blood levels as a simple index for ongoing inflammation. In many pathologies, which involves many different tissues, stages of disease, treatments, and responses to treatments, its interpretive diagnostic value requires a deeper understanding of the localized tissue processes and events that contribute signals which regulate protective or pathological host defense bioactivities. This report presents concepts that describe how local tissue activation events can lead to a non-proteolytic, conformational rearrangement of CRP into a unique isoform with distinctive solubility, antigenicity, binding reactivities and bioactivities from that protein widely known and measured in serum. By describing factors that control the expression, tissue localization, half-life and pro-inflammatory amplification activity of this CRP isoform, a unifying explanation for the diagnostic significance of CRP measurement in disease is advanced.

Duplex Shiny app quantification of the sepsis biomarkers C-reactive protein and interleukin-6 in a fast quantum dot labeled lateral flow assay

Fast point-of-care (POC) diagnostics represent an unmet medical need and include applications such as lateral flow assays (LFAs) for the diagnosis of sepsis and consequences of cytokine storms and for the treatment of COVID-19 and other systemic, inflammatory events not caused by infection. Because of the complex pathophysiology of sepsis, multiple biomarkers must be analyzed to compensate for the low sensitivity and specificity of single biomarker targets. Conventional LFAs, such as gold nanoparticle dyed assays, are limited to approximately five targets-the maximum number of test lines on an assay. To increase the information obtainable from each test line, we combined green and red emitting quantum dots (QDs) as labels for C-reactive protein (CRP) and interleukin-6 (IL-6) antibodies in an optical duplex immunoassay. CdSe-QDs with sharp and tunable emission bands were used to simultaneously quantify CRP and IL-6 in a single test line, by using a single UV-light source and two suitable emission filters for readout through a widely available BioImager device. For image and data processing, a customized software tool, the MultiFlow-Shiny app was used to accelerate and simplify the readout process. The app software provides advanced tools for image processing, including assisted extraction of line intensities, advanced background correction and an easy workflow for creation and handling of experimental data in quantitative LFAs. The results generated with our MultiFlow-Shiny app were superior to those generated with the popular software ImageJ and resulted in lower detection limits. Our assay is applicable for detecting clinically relevant ranges of both target proteins and therefore may serve as a powerful tool for POC diagnosis of inflammation and infectious events.

Low-grade inflammation independently associates with cardiometabolic risk in children with overweight/obesity

BACKGROUND AND AIMS

Pediatric obesity associates with both low-grade inflammation and cardiometabolic risk on the population level. Yet on an individual patient level, overweight/obesity does not always equal increased cardiometabolic risk. In this study, we examine whether low-grade inflammation associates with cardiometabolic risk in Danish children, independent of degree of adiposity. We further assess the value of integrating multiple inflammation markers to identify children with very-high cardiometabolic risk profiles.

METHOD AND RESULTS

We studied 2192 children and adolescents aged 6-18 years from an obesity clinic cohort and a population-based cohort, in a cross-sectional study design. Anthropometry, blood pressure, pubertal stage and body composition by dual-energy X-ray absorptiometry were assessed, and biomarkers including fasting serum high sensitivity C-reactive protein (hsCRP), white blood cells (WBC), resistin, lipid profile and glucose metabolism were measured. Adjusted correlation analysis and odds ratios were calculated. We found that, independent of degree of adiposity, having high-normal inflammation marker concentrations associated with increased cardiometabolic risk: for girls, hsCRP >0.57-9.98 mg/L (mid/upper tertile) associated with ~2-fold higher odds of dyslipidemia and hepatic steatosis (vs. lower tertile). For both sexes, WBC >7.0-12.4 10⁹/L (upper tertile) associated with 2.5-fold higher odds of insulin resistance. Lastly, children with multiple inflammation markers in the high-normal range exhibited the most severe cardiometabolic risk profile.

CONCLUSION

Low-grade inflammation associates with cardiometabolic risk in children independent of degree of adiposity. The associations vary with sex and inflammation marker measured. Finally, integrating multiple low-grade inflammation markers identifies a very-high-risk subgroup of children with overweight/obesity and may have clinical value.

Colorectal cancer is associated with increased circulating lipopolysaccharide, inflammation and hypercoagulability

Gut dysbiosis contributes to the development of a dysfunctional gut barrier, facilitating the translocation of bacteria and inflammagens, and is implicated in colorectal cancer (CRC) pathogenesis. Such 'leaky gut' conditions result in systemic inflammation, of which a hallmark is increased hypercoagulability. Fluorescence antibody confocal microscopy was used to determine circulating levels of lipopolysaccharide (LPS) in control and CRC populations. Here we showed that circulating levels of LPS are significantly elevated in the CRC population. We also showed that markers of inflammation and hypercoagulability are increased in this population. Furthermore, anomalous blood clotting and structural changes in blood components are presented. Importantly, the association between LPS levels, inflammation, and hematological dysfunction was analysed. Statistical regression models were applied to identify markers with strong association with CRC, and to investigate the correlation between markers. A core aim is enhanced biomarker discovery for CRC. We conclude that circulating LPS can promote systemic inflammation and contribute to the development of a pathological coagulation system, with resulting chronic inflammation and an activated coagulation system implicated in tumorigenesis. Blood-based screening tools are an emerging research area of interest for CRC screening. We propose the use of additional (novel) biomarkers to effectively screen for CRC.

Detrimental Effect of C-Reactive Protein on the Cardiometabolic Cells and Its Rectifying by Metabolic Surgery in Obese Diabetic Patients

BACKGROUND

High-sensitivity C-reactive protein (hs-CRP) has been regarded as a biomarker of low-degree inflammation in illness; however, whether CRP exerts its pathogenic effect on the cardiometabolic system remains unknown. Aside from the beneficial effects of metabolic surgery on cardiometabolic system, its impact on inflammation still worth examining. Thus, this study aims to investigate the effect of CRP on adipose and vascular cells, and their responses to metabolic surgery in obese diabetic patients.

PATIENTS AND METHODS

The expression of CRP and RAS- and ERK-related factors in the adipocytes and VSMCs were measured. Obese patients with type 2 diabetes who underwent metabolic surgery were followed up for 2 years thereafter. Laboratory tests, which included serum hs-CRP levels and visceral fat thickness (VFT), were obtained before and after surgery.

RESULTS

CRP administration significantly and dose-dependently increased the intracellular-free calcium concentration ([Ca2+]i) in cultured adipocytes and in the VSMCs. CRP administration significantly increased ACE, Ang II, AT1R and p-ERK expressions, but reduced ACE2 expression in both the adipocytes and VSMCs. Clinical study showed that VFT was closely associated with serum hs-CRP. Furthermore, VFT and serum hs-CRP were found to be highly associated with blood pressure. Finally, metabolic surgery remarkably decreased blood pressure, visceral fat and serum hs-CRP levels.

CONCLUSION

CRP has a detrimental effect on cardiometabolic cells, aside from functioning merely as a biomarker. Serum hs-CRP levels are highly associated with hypertension and visceral obesity, which can be antagonized by metabolic surgery in obese diabetic patients.

The impact of a randomized dietary and physical activity intervention on chronic inflammation among obese African-American women

Lifestyle interventions may reduce inflammation and lower breast cancer (BrCa) risk. This randomized trial assessed the impact of the Sistas Inspiring Sistas Through Activity and Support (SISTAS) study on plasma C-reactive protein (CRP), interleukin-6 (IL-6) and Dietary Inflammatory Index (DII). This unblinded, dietary and physical activity trial was implemented in 337 obese (body mass index [BMI] ≥30 kg/m²) African American (AA) women recruited between 2011 and 2015 in South Carolina through a community-based participatory approach with measurements at baseline, 3 months, and 12 months. Participants were randomized into either intervention (n = 176) or wait-list control group (n = 161). Linear mixed-effect models were used for analyses of CRP and IL-6. Baseline CRP was significantly higher in those with greater obesity, body fat percentage, and waist circumference (all p <.01). No difference was observed between groups for CRP or IL-6 at 3 or 12 months; however, improvements in diet were observed in the intervention group compared to the control group (p = .02) at 3 months but were not sustained at 12 months. Although the intervention was not successful at reducing levels of CRP or IL-6, a significant decrease was observed in DII score for the intervention group, indicating short-term positive dietary change.

Associations of Inflammation, Physical Activity, and Sleep in a Diverse Population of Women

Background: Cardiovascular disease (CVD) is the leading cause of mortality in United States with a recent rise seen in young adults, particularly women. Systemic inflammation, physical activity, and sleep are each individually linked to CVD risk. Whether there is an interaction of these variables, however, is unclear. We evaluated physical activity and sleep among racially ethnically diverse women, ages 20-79 years, to assess associations with systemic inflammation. Methods: We performed a cross-sectional study of 506 women (61% racial/ethnic minority; mean (standard deviation [SD]) age = 37 [15.7] years, body mass index 26.0 [5.7] kg/m²) enrolled in the American Heart Association (AHA) Go Red for Women Strategically Focused Research Network at Columbia University Irving Medical Center (CUIMC). Inflammation, assessed by C-reactive protein (CRP), was analyzed in the Biomarkers Core Laboratory at CUIMC. Physical activity and sleep were assessed using validated questionnaires. Multivariable models adjusted for demographic and clinical confounders were used to evaluate associations between CRP, physical activity, and sleep. Results: Mean (SD) physical activity was 282 (557.2) minutes/week, and mean (SD) sleep duration was 6.75 (1.24) hours/night. Mean CRP was 2.08 (3.56), and 17% of participants were categorized as high risk for obstructive sleep apnea (OSA). Participants who slept <6 hours/night were less likely to be physically active ≥150 minutes/week (odds ratios, ORs [95% confidence interval, CI]: 0.53 [0.33-0.84]). This association was nonsignificant after adjustment. High risk of OSA was associated with CRP ≥2 mg/L (OR [95% CI]: 1.91 [1.11-3.30]) following adjustment. Stratification by race/ethnicity showed that high risk of OSA was associated with CRP ≥2 mg/L among racial/ethnic minorities but not white women (OR [95% CI]: 2.75 [1.43-5.30] vs. 0.94 [0.31-2.88]). Conclusion: High risk of OSA and elevated CRP was significantly associated in women, particularly minority women. Both play a role in CVD, highlighting potential causes for the increased risk of CVD in younger women.

Biological variation of metabolic cardiovascular risk factors in haemodialysis patients and healthy individuals

Background

Maintenance haemodialysis (HD) is associated with a very high cardiovascular risk and the assessment of metabolic cardiovascular risk factors is essential for an adequate diagnosis and management. The aim of the study has been to estimate the biological variation (BV) of serum lipids, calcium, inorganic phosphorus, 25-OH vitamin D, C-reactive protein and plasma intact parathyroid hormone (PTHi) and total homocysteine, to evaluate whether HD alter the homeostatic set-point of these magnitudes.

Methods

Blood samples were collected from 18 HD patients in steady-state conditions, one per month during 6 months, and from 11 healthy volunteers at weekly intervals over 5 weeks. BV data were derived using CV-ANOVA.

Results

Within-subject coefficients of variation (CVI) and derived reference change values (RCV) estimated in HD patients were significantly higher than in healthy individuals for calcium (CVI =3.8% vs. 2.3%) (RCV =12.6% vs. 7.6%), inorganic phosphorus (13.1% vs. 8.0%) (RCV =38.7% vs. 30.1%) and PTHi (20.3% vs. 11.3%) (RCV =57.5% vs. 34.0%).

Conclusions

For calcium, inorganic phosphorus and PTHi, RCV derived from advanced disease-specific BV data is recommended for the management of bone-mineral disturbances in HD patients. For the rest of cardiovascular risk factors, the use of RCV derived from healthy individuals could be appropriate.

Neopterin is Associated with Disease Severity and Outcome in Patients with Non-Ischaemic Heart Failure

Inflammation and immune activation play an important role in the pathogenesis of cardiac remodelling in patients with heart failure. The aim of this study was to assess whether biomarkers of inflammation and immune activation are linked to disease severity and the prognosis of heart failure patients. In 149 patients (65.8% men, median age 49.7 years) with heart failure from nonischaemic cardiomyopathy, the biomarkers neopterin and C-reactive protein were tested at the time of diagnosis. Patients were followed-up for a median of 58 months. During follow-up, nineteen patients died, five had a heart transplantation, two needed a ventricular assistance device, and twenty-one patients had to be hospitalised because of heart failure decompensation. Neopterin concentrations correlated with N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations (rs = 0.399, p < 0.001) and rose with higher New York Heart Association (NYHA) class (I: 5.60 nmol/L, II: 6.90 nmol/L, III/IV: 7.80 nmol/L, p = 0.033). Higher neopterin levels were predictive for an adverse outcome (death or hospitalisation due to HF decompensation), independently of age and sex and of established predictors in heart failure such as NYHA class, NT-proBNP, estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LV-EF) (HR 2.770; 95% CI 1.419-5.407; p = 0.003). Patients with a neopterin/eGFR ratio ≥ 0.133 (as a combined marker for immune activation and kidney function) had a more than eightfold increased risk of reaching an endpoint compared to patients with a neopterin/eGFR ratio ≤0.065 (HR 8.380; 95% CI 2.889-24.308; p < 0.001). Neopterin is associated with disease severity and is an independent predictor of prognosis in patients with heart failure.