Related Experiment Video
Updated: Jun 25, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
"Poor man's risk factor": correlation between high sensitivity C-reactive protein and socio-economic class in
Rishi Sethi1, Aniket Puri, Aman Makhija
1Department of Cardiology, King George Medical University, Lucknow, India.
Insights
Lower socioeconomic status (SES) is linked to higher high-sensitivity C-reactive protein (hs-CRP) levels, a marker of inflammation, in acute coronary syndrome patients. This suggests inflammation may play a key role in cardiovascular disease development, particularly in lower SES individuals without traditional risk factors.
Area of Science:
- Cardiovascular Medicine
- Inflammation Research
- Public Health
Background:
- Inflammation is implicated in coronary artery disease (CAD) pathogenesis.
- High-sensitivity C-reactive protein (hs-CRP) is a key inflammatory marker.
- Socioeconomic status (SES) may influence CAD risk and inflammatory markers.
Purpose of the Study:
- To investigate the correlation between hs-CRP levels and SES in patients with acute coronary syndrome (ACS).
- To explore the relationship between inflammation, SES, and traditional cardiovascular risk factors.
Main Methods:
- Baseline hs-CRP levels were measured in 490 ACS patients using turbidimetric immunoassay.
- Patients were stratified by hs-CRP levels (low, intermediate, high) and SES (lower, middle, upper) using the Kuppuswami Index.
- Traditional CAD risk factors (diabetes, hypertension, dyslipidemia, smoking) were recorded.
Main Results:
- Mean hs-CRP levels were significantly higher in lower SES patients (2.3 mg/L) compared to middle (0.8 mg/L) and upper SES (1.2 mg/L) groups.
- Lower SES patients exhibited higher hs-CRP levels despite having fewer traditional risk factors and lower Framingham risk scores.
- Smoking was the only traditional risk factor significantly more prevalent in lower SES patients (73%).
Conclusions:
- Patients with lower SES demonstrate significantly elevated hs-CRP levels, indicating higher inflammation.
- Inflammation, as indicated by hs-CRP, may be a crucial link in atherosclerosis pathophysiology, especially in lower SES individuals.
- These findings highlight the importance of considering inflammation in cardiovascular disease management across different socioeconomic strata.
Objective:
Inflammation has been proposed as one of the factors responsible for the development of coronary artery disease (CAD) and high sensitivity C-reactive protein (hs CRP) at present is the strongest marker of inflammation. We did a study to assess the correlation of hs-CRP with socio-economic status (SES) in patients of CAD presenting as acute coronary syndrome (ACS).
Methods:
Baseline hs-CRP of 490 patients of ACS was estimated by turbidimetric immunoassay. Patients were stratified by levels of hs-CRP into low (<1 mg/L); intermediate (1-3 mg/L) or high (>3 mg/L) groups and in tertiles of 0-0.39 mg/L, 0.4-1.1 mg/L and >1.1 mg/L, respectively. Classification of patient into upper (21.4%), middle (45.37 percent) and lower (33.3%) SES was based on Kuppuswami Index which includes education, income and profession. Presence or absence of traditional risk factors for CAD diabetes, hypertension, dyslipidemia and smoking was recorded in each patient.
Results:
Mean levels of hs-CRP in lower, middle and upper SES were 2.3 +/- 2.1 mg/L, 0.8 +/- 1.7 mg/L and 1.2 +/- 1.5 mg/L, respectively. hs-CRP levels were significantly higher in low SES compared with both upper SES (p = 0.033) and middle SES (p = 0.001). Prevalence of more than one traditional CAD risk factors was seen in 13.5%, 37.5% and 67.67 percent; in patient of lower, middle and upper SES. It was observed that multiple risk factors had a linear correlation with increasing SES. Of the four traditional risk factors of CAD, smoking was the only factor which was significantly higher in lower SES (73%) as compared to middle (51.67 percent;) and upper (39.4%) SES. We found that 62.3%, 20.8% and 26.5% patients of low, middle and upper SES had hs-CRP values in the highest tertile. Median value of the Framingham risk score in low, middle and upper SES as 11, 14 and 18, respectively. We observed that at each category of Framingham risk, low SES had higher hs-CRP.
Conclusion:
We conclude from our study that patient of lower SES have significantly higher levels of hs-CRP despite the fact that they have lesser traditional risk factors and lower Framingham risk. These findings add credit to our belief that inflammation may be an important link in the pathophysiology of atherosclerosis and its complications especially in patients of low SES who do not have traditional risk factors.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations