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Diagnostic performance of plasma high sensitive C-reactive protein in detecting three-vessel coronary artery disease:

Ari Mennander1, Pekka Kuukasjärvi, Jari Laurikka

  • 1Heart Center, Tampere University Hospital and Tampere University Medical School, Tampere, Finland. ari.mennander@pshp.fi

Scandinavian Journal of Clinical and Laboratory Investigation
|July 9, 2008
PubMed

Insights

High-sensitivity C-reactive protein (hsCRP) effectively detects severe coronary artery disease (CAD) in individuals without the apoE epsilon4 allele. Its diagnostic accuracy for CAD is reduced in apoE epsilon4 carriers.

Area of Science:

  • Cardiovascular Medicine
  • Genetics
  • Biomarkers

Background:

  • Plasma high-sensitivity C-reactive protein (hsCRP) is a key indicator of systemic inflammation and a risk factor for coronary artery disease (CAD).
  • The apolipoprotein E (apoE) epsilon4 allele is also an established risk factor for CAD.
  • The interplay between hsCRP and apoE epsilon4 status in diagnosing severe CAD requires further investigation.

Purpose of the Study:

  • To evaluate whether apoE epsilon4 carrier status modifies the diagnostic performance of plasma hsCRP in detecting severe 3-vessel CAD.
  • To assess the accuracy of hsCRP in identifying significant coronary atherosclerosis based on genetic predisposition.

Main Methods:

  • The study included 485 Finnish subjects undergoing coronary angiography.
  • ApoE genotypes were determined using PCR, and hsCRP levels were measured via an automatic analyzer.
  • Receiver operating characteristic (ROC) curve analysis was employed to assess diagnostic performance in apoE epsilon4 non-carriers and carriers separately.

Main Results:

  • hsCRP demonstrated significant diagnostic performance for 3-vessel CAD in apoE epsilon4 non-carriers (AUC 0.646, p=0.0001).
  • In contrast, hsCRP did not significantly predict 3-vessel CAD in apoE epsilon4 carriers (AUC 0.518, p=0.719).
  • A significant interaction between apoE epsilon4 status and hsCRP levels (<1.0 mg/L vs. >=1.0 mg/L) was observed in relation to 3-vessel CAD incidence, with high hsCRP significantly associated with CAD in non-carriers.

Conclusions:

  • The diagnostic accuracy of hsCRP for distinguishing severe 3-vessel CAD is significantly higher in individuals without the apoE epsilon4 allele.
  • The presence of the apoE epsilon4 allele diminishes the utility of hsCRP as a diagnostic marker for severe coronary atherosclerosis.
Abstract

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