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The relationship between C-reactive protein and subclinical cardiovascular disease in the Diabetes Heart Study (DHS)
Donald W Bowden1, Leslie A Lange, Carl D Langefeld
1Department of Biochemistry, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. dbowden@wfubmc.edu
Insights
C-reactive protein (CRP) levels do not predict subclinical cardiovascular disease (CVD) in high-risk individuals. This study found no significant association between CRP and measures of subclinical CVD after adjusting for covariates.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Epidemiology
Background:
- C-reactive protein (CRP) is a known predictor of cardiovascular disease (CVD).
- Subclinical CVD assessment is crucial in high-risk populations.
- Type 2 diabetes mellitus (T2DM) is a significant risk factor for CVD.
Purpose of the Study:
- To evaluate the association between CRP levels and subclinical CVD measures.
- To investigate CRP's predictive value in a high-risk cohort, including individuals with T2DM.
- To assess subclinical CVD using coronary artery calcium (CAC) and intimal-medial thickness (IMT).
Main Methods:
- A family-based study of 666 subjects (551 with T2DM) with an average age of 61.
- Measured CRP, CAC, and carotid artery IMT.
- Used generalized estimating equations to analyze associations, adjusting for covariates and sibling correlation.
Main Results:
- CRP showed a weak, negative association with CAC quantity (P=.01) in unadjusted analysis.
- This association became non-significant after adjusting for covariates.
- No significant association was found between CRP and IMT or presence of CAC.
Conclusions:
- CRP levels did not show an incremental association with measures of subclinical CVD in this high-risk population.
- Findings suggest CRP may not be a reliable independent predictor of subclinical CVD in this cohort.
- Further research may be needed to clarify CRP's role in specific subgroups.
Background:
Epidemiological studies suggest that levels of C-reactive protein (CRP) predict cardiovascular disease (CVD). We have evaluated the relationship between CRP and subclinical CVD in a study cohort at high risk of CVD.
Methods:
The DHS is a single-center, family-based study of the genetic and environmental components of CVD in type 2 diabetes mellitus (T2DM). We evaluated 666 subjects (551 T2DM affected and 115 unaffected) with an average age of 61 years. Measures of coronary artery calcium (CAC), intimal-medial thickness (IMT) of the common carotid artery, and CRP were obtained on all subjects.
Results:
C-reactive protein is positively and significantly associated with female sex, body mass index, and smoking and is negatively and significantly associated with age and statin use. Generalized estimating equations were used to test whether CRP was associated with each subclinical CVD measure (presence/absence of CAC, quantity of CAC, and IMT) adjusting for covariates and correlation among siblings. Stratified analyses were conducted to examine whether these associations differed across sex and statin use. In the overall analysis, CRP was not significantly associated with IMT or presence of CAC but was negatively and significantly associated with quantity of CAC (P = .01). When covariates were added, the relationship was no longer significant. Similar patterns were observed in stratified analyses based on sex, statin use, and diabetes status: weak but negative association of CAC with CRP, which became nonsignificant with adjustment for covariates.
Conclusions:
In a population at high risk for CVD, there was no evidence of incremental association of CRP levels with measures of subclinical CVD.
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