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C-reactive protein and carotid intimal medial thickness in a community population
Matthias Sitzer1, Hugh S Markus, Michael A Mendall
1Department of Neurology, J.W. Goethe-University Frankfurt am Main, Germany, St George's Hospital Medical School, London, UK. sitzer@em.uni-franfurt.de
Insights
C-reactive protein (CRP) may not independently cause atherosclerosis, but chronic inflammation it indicates might link obesity to the disease process. Further research is needed to clarify this relationship.
Area of Science:
- Cardiovascular Medicine
- Inflammation Research
- Atherosclerosis Studies
Background:
- C-reactive protein (CRP) is associated with cardiovascular disease and atherosclerosis.
- Epidemiological studies link CRP levels to increased risk of stroke, myocardial infarction, and peripheral arterial disease.
- The independent role of serum CRP in the atherosclerotic process remains unclear.
Purpose of the Study:
- To investigate the relationship between carotid intimal medial thickness (IMT) and serum CRP levels.
- To determine if CRP is an independent indicator of early atherosclerotic changes.
- To assess the influence of conventional vascular risk factors on the CRP-IMT association.
Main Methods:
- A community-based sample of 1018 individuals without advanced atherosclerotic disease was studied.
- Carotid intimal medial thickness (IMT) was measured.
- The association between IMT, serum CRP, and conventional vascular risk factors (smoking, obesity, hypertension, diabetes, hypercholesterolemia) was analyzed using linear regression.
Main Results:
- A significant association was found between increasing IMT and increasing CRP values in the carotid system.
- This relationship weakened after adjusting for conventional risk factors, particularly body mass index, but remained significant.
- The association became non-significant when fibrinogen was included in the regression model.
Conclusions:
- Serum CRP is unlikely to be a primary independent cause of early arteriosclerosis.
- Elevated CRP, reflecting chronic inflammation, may mediate the atherogenic effects of conventional risk factors, especially obesity.
- Inflammation indicated by CRP might play a role in linking obesity to the development of atherosclerosis.
Background:
C-reactive protein (CRP) has been linked to cardiovascular disease and atherosclerosis. Large-scale epidemiological studies have shown a correlation of CRP level with risk of stroke, myocardial infarction and peripheral arterial disease. Nevertheless, the question whether serum CRP itself is an independent indicator of the atherosclerotic process remains unanswered.
Methods:
In a community-based sample free of advanced atherosclerotic disease (n = 1018; mean age +/- SD, 54.1 +/- 12.0 years; 49.7% women) we examined the relationship between carotid intimal medial thickness (IMT), conventional vascular risk factors (that is, smoking, obesity, elevated blood pressure, diabetes mellitus, hypercholesterolaemia) and serum CRP.
Results:
We found an association between increasing IMT values with increasing CRP values for all sites within the carotid system (for example, common carotid artery [CCA-] IMT, beta = 0.174, P < 0.001). The relationship was weakened after accounting for the above-mentioned conventional risk factors (linear regression), particularly body mass index, but remained significant (for example, mean CCA-IMT beta = 0.02, P = 0.042). Including fibrinogen in the regression made the relationship no longer significant (mean CCA-IMT beta = 0.01, P = 0.277).
Conclusion:
It is unlikely that CRP per se is a major independent cause of early arteriosclerosis. Elevations of CRP, or less specifically chronic inflammation, may mediate the effect of certain conventional risk factors on promoting atherogenesis, especially obesity.