Elsevier

American Heart Journal

Volume 141, Issue 2, February 2001, Pages 206-210
American Heart Journal

Acute Ischemic Heart Disease
C-reactive protein is not associated with the presence or extent of calcified subclinical atherosclerosis*,**

Presented at the 73rd Scientific Session of the American Heart Association, New Orleans, La, November 15, 2000.
https://doi.org/10.1067/mhj.2001.112488Get rights and content

Abstract

Background Both high-sensitivity C-reactive protein (hsCRP) and electron beam computed tomography (EBCT) coronary artery calcification (CAC) are valid markers of cardiovascular risk. It is unknown whether hsCRP is a marker of atherosclerotic burden or whether it reflects a process (eg, inflammatory fibrous cap degradation) leading to acute coronary events. Methods A nested case-control study was performed of 188 men enrolled in the Prospective Army Coronary Calcium study. The serum hsCRP levels (latex agglutination assay) were evaluated in subjects with CAC (CAC score >0, n = 94) and compared with age- and smoking status–matched control subjects (CAC score 0, n = 94). Results Levels of hsCRP in the highest quartile were related to the following coronary risk factors: smoking status, low-density lipoprotein cholesterol, body mass index, glycosylated hemoglobin, fibrinogen, and homocysteine. The mean hsCRP level was similar in cases (+CAC, 0.20 ± 0.22 mg/dL) and controls (–CAC, 0.19 ± 0.21 mg/dL; P =.81) and was unrelated to the log-transformed CAC score (r < 0.01, P =.91). Multivariable analysis controlling for standard risk factors, aspirin, and statin therapy found only that low-density lipoprotein cholesterol was related to CAC. Conclusions Despite associations with standard and emerging cardiovascular risk factors, hsCRP is unrelated to the presence and extent of calcified subclinical atherosclerosis. This implies that CAC (a disease marker) and hsCRP (a process marker) may be complementary for the prediction of cardiovascular risk. (Am Heart J 2001;141:206-10.)

Section snippets

Methods

This study was approved by the Walter Reed Army Medical Center Department of Clinical Investigation. Subjects for this nested case-control analysis were selected from the PACC.13 Briefly, the PACC cohort consists of active-duty Army personnel between the ages of 40 and 45 years who voluntarily participated in the study at the time of a mandatory periodic Army physical examination. The study procedures included a health risk appraisal, serologic testing for cardiovascular risk factors, and an

Results

The hsCRP level varied according to smoking status. Current smokers, ex-smokers, and subjects who denied a smoking history demonstrated levels of 0.34 ± 0.29 mg/dL, 0.21 ± 0.25 mg/dL, and 0.17 ± 0.19 mg/dL, respectively (P =.02). Table I displays the demographic and serologic measurements.Cases had significantly higher values for total and low-density lipoprotein (LDL) cholesterol as previously reported (Taylor et al, unpublished data).

The mean hsCRP levels were similar in cases and controls

Discussion

Postulated mechanisms for the association between hsCRP and the development of coronary heart disease include a possible relationship to the extent of coronary atherosclerosis (ie, a disease marker) or the extent of inflammation within the atherosclerosis present (ie, a process marker). In this case-control study of healthy middle-aged men, we compared hsCRP to the presence and extent of CAC, a validated atherosclerosis surrogate for the presence and extent of atherosclerosis. The principal

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    *

    The opinions or assertions herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army of the Department of Defense.

    **

    Reprint requests: Allen J. Taylor, MD, Cardiology Service, Walter Reed Army Medical Center, Building 2, Room 4A, Washington, DC 20307-5001. E-mail: [email protected]

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