Abstract P004: Association of C-Reactive Protein with Incident Coronary Events in Blacks and Whites: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Neil A Zakai ◽  
Mary Cushman ◽  
Leslie A McClure ◽  
Todd M Brown ◽  
Stephen P Glasser ◽  
...  

Background: Elevated C-reactive protein (CRP) is associated with coronary heart disease (CHD) risk independent of traditional CHD risk factors. Few studies include many non-white participants despite known racial differences in CRP. We assessed whether there were racial differences in the association between CRP and incident CHD in a large cohort of AA and white Americans. Methods: 30,239 AAs and whites were enrolled and examined in their homes across the US from 2003-07. CHD, defined as myocardial infarction or acute CHD death, was captured by participant report and physician medical record review. We used Cox models in those free of CHD at baseline to assess the association of CRP with incident CHD. Results: Over a median 3.7 years follow-up (maximum 5.9 years), 505 CHD events occurred in 24,297 individuals without baseline CHD (223 in 10,337 AA). AA had higher levels of many traditional CHD risk factors, including hypertension (69% vs 47%), diabetes (28% vs 13%), current smoking (17% vs 12%, all <0.01), but higher high-density lipoprotein cholesterol (54 vs 52 mg/dL, p<0.01) and similar total cholesterol (195 vs 192 mg/dL, p=0.16). Median CRP was higher in AA than whites (2.85 vs 1.82 mg/L, p<0.01), with 4,615/9,558 (48%) of blacks vs. 4,548/13,217 (34%) of whites having a CRP ≥3 mg/L (p<0.01) . The table presents the HR of CHD for CRP ≥3 mg/L and per 1 unit increase in log CRP stratified by race. AA did not have a higher hazard of CHD than whites in any model (data not shown). Discussion: Despite higher levels of CRP in AA, CRP was not differentially associated with CHD between AA and whites. Though the HR for CRP ≥3 mg/L appeared weaker in AA vs. whites this was not supported by a significant p-interaction. The paradox of an adverse CHD risk factor profile but similar risk of CHD was not explained by differential associations of CRP with CHD in AA vs. whites. Further analyses of fatal and non-fatal MI as well as the performance of traditional and non traditional CHD risk factors in AA vs. whites are warranted. Table Association of CRP with Incident CHD in African-Americans and Whites All HR (95% CI) Blacks HR (95% CI) Whites HR (95% CI) P-interaction between race and CRP CRP ≥3 mg/L Model 1 1.63 (1.35, 1.96) 1.46 (1.11, 1.93) 1.75 (1.37, 2.24) 0.57 Model 2 1.37 (1.14, 1.66) 1.26 (0.95, 1.67) 1.46 (1.13, 1.88) 0.52 Model 3 1.33 (1.10, 1.61) 1.20 (0.90, 1.61) 1.41 (1.10, 1.82) 0.58 Per 1 unit increase in log CRP Model 1 1.32 (1.22, 1.43) 1.29 (1.15, 1.45) 1.34 (1.20, 1.49) 0.95 Model 2 1.23 (1.13, 1.33) 1.23 (1.09, 1.39) 1.22 (1.09, 1.36) 0.81 Model 3 1.21 (1.12, 1.31) 1.21 (1.07, 1.37) 1.20 (1.07, 1.34) 0.73 Model 1: Age, Sex, and Region Model 2: Model 1 + Hypertension, Diabetes, Smoking, Total Cholesterol, HDL Cholesterol, Taking Dyslipidemia Meds Model 3: Model 2 + Income, Education

2001 ◽  
Vol 2 (2) ◽  
pp. 124
Author(s):  
J. Patel ◽  
A. Vyas ◽  
L. James ◽  
V. Karadia ◽  
E. Hughes ◽  
...  

2021 ◽  
pp. 1-23
Author(s):  
Hanna-Mari Tertsunen ◽  
Sari Hantunen ◽  
Tomi-Pekka Tuomainen ◽  
Jukka T. Salonen ◽  
Jyrki K. Virtanen

Abstract Healthy Nordic diet has been beneficially associated with coronary heart disease (CHD) risk factors, but few studies have investigated risk of developing CHD. We investigated the associations of healthy Nordic diet with major CHD risk factors, carotid atherosclerosis, and incident CHD in middle-aged and older men from eastern Finland. A total of 1981 men aged 42-60 years and free of CHD at baseline in 1984-1989 were investigated. Diet was assessed with 4-d food recording and the healthy Nordic diet score was calculated based on the Baltic Sea Diet Score. Carotid atherosclerosis was assessed by ultrasonography of the common carotid artery intima-media thickness in 1053 men. Analysis of covariance and Cox proportional hazards regression analyses were used for analyses. Healthy Nordic diet score associated with lower serum C-reactive protein concentrations (multivariable-adjusted extreme-quartile difference 0.69 mg/L, 95% confidence interval 0.15-1.22 mg/L), but not with serum lipid concentrations, blood pressure, or carotid atherosclerosis. During the average follow-up of 21.6 years (SD 8.3 years), 407 men had a CHD event, of which 277 were fatal. The multivariable-adjusted hazard ratios (95% confidence interval) in the lowest vs. the highest quartile of the healthy Nordic diet score were 1.10 (0.85-1.45) for any CHD event (P-trend 0.429) and 1.38 (0.95-2.00) (P-trend 0.119) for fatal CHD event. We did not find evidence that adherence to a healthy Nordic diet would be associated with a lower risk of CHD or with carotid atherosclerosis or major CHD risk factors, except for an inverse association with serum C-reactive protein concentrations.


2019 ◽  
Vol 17 (6) ◽  
pp. 591-594 ◽  
Author(s):  
John C. Stevenson ◽  
Sophia Tsiligiannis ◽  
Nick Panay

Cardiovascular disease, and particularly coronary heart disease (CHD), has a low incidence in premenopausal women. Loss of ovarian hormones during the perimenopause and menopause leads to a sharp increase in incidence. Although most CHD risk factors are common to both men and women, the menopause is a unique additional risk factor for women. Sex steroids have profound effects on many CHD risk factors. Their loss leads to adverse changes in lipids and lipoproteins, with increases being seen in low density lipoprotein (LDL) cholesterol and triglycerides, and decreases in high density lipoprotein (HDL) cholesterol. There is a reduction in insulin secretion and elimination, but increases in insulin resistance eventually result in increasing circulating insulin levels. There are changes in body fat distribution with accumulation in central and visceral fat which links to the other adverse metabolic changes. There is an increase in the incidence of hypertension and of type 2 diabetes mellitus, both major risk factors for CHD. Oestrogens have potent effects on blood vessels and their loss leads to dysfunction of the vascular endothelium. All of these changes result from loss of ovarian function contributing to the increased development of CHD. Risk factor assessment in perimenopausal women is recommended, thereby permitting the timely introduction of lifestyle, hormonal and therapeutic interventions to modify or reverse these adverse changes.


Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 255
Author(s):  
Valeria Galetti ◽  
Marica Brnic ◽  
Benjamin Lotin ◽  
Mauro Frigeri

Fasting is becoming an increasingly popular practice. Nevertheless, its clinical benefits and possible inconveniences remain limitedly evaluated. We observed the effects of a seven-day fast conducted in a non-medical center located in the Swiss Alps. Clinical parameters were measured on the first and last day of fasting (D1 and D7), and two months later (D60). Among the 40 participants, blood analyses were done on 25 persons with an increased metabolic risk, with the primary goal of assessing the lasting effect on low-density lipoprotein (LDL) cholesterol. By comparing D60 with D1, high-density lipoprotein cholesterol (HDL) (+0.15 mmol/L) and insulin-like growth factor-1 (IGF-1) (+2.05 mmol/L) increased (both p < 0.009), all other blood parameters (LDL, glucose, total cholesterol, triglycerides, C-reactive protein (CRP)) did not change; weight (−0.97 kg) and hearth rate (−7.31 min−1) decreased (both p < 0.006). By comparing D7 with D1, total cholesterol (+0.44 mmol/L), triglycerides (+0.37 mmol/L) and CRP (+3.37 mg/L) increased (all p < 0.02). The lack of LDL variation at D60 may be due to the low metabolic risk level of the participants. The increase of total cholesterol, triglycerides and CRP at D7 warrants studies to understand whether such fluctuations represent a stress reaction to the fasting state, which may vary in different fasting types.


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Kaitlyn M Peper ◽  
Boyi Guo ◽  
Leann Long ◽  
George Howard ◽  
April P Carson ◽  
...  

Introduction: Black Americans have a higher incidence of diabetes and have elevated inflammatory biomarkers compared to white Americans. Elevated inflammation is a risk factor for diabetes but the impact of inflammation on the racial disparity in diabetes is unknown. Hypothesis: Elevated C-reactive protein (CRP) attenuates the observed black-white difference in incident diabetes. Methods: REGARDS enrolled 30,239 black and white adults aged ≥45 years from the contiguous US in 2003-07. This analysis included REGARDS participants without baseline diabetes who were assessed for diabetes 9 years later. RRs for incident diabetes by race were calculated using modified Poisson regression adjusting for risk factors known to contribute to the racial difference in diabetes incidence. The attenuation by CRP of the black-white RR of incident diabetes was calculated as the percent difference in the race RR in models with and without CRP adjustment; 95% CI for the difference was estimated using bootstrapping. Results: Of 11,073 participants without baseline diabetes (33% black, 67% white), black participants had higher CRP than white participants, and 12.5% developed incident diabetes. The black-white RR for incident diabetes in the base model was 1.74 (95% CI: 1.52, 1.99) for women and 1.44 (1.25, 1.66) for men. Baseline CRP mediated 21% (14, 29%) of this association in women and 20% (12, 34%) in men. These percent attenuations were similar in models adjusting for other diabetes risk factors but were diminished in a fully adjusted model; 5% (-4, 25%) in women and 7% (-43, 50%) in men (Figure). Conclusion: Adjustment for CRP in base models accounted for 20% and 21% of the excess risk of incident diabetes observed in black men and women, respectively, in this study. This substantial mediation persisted after adjusting for other risk factors but was diminished in the fully adjusted model. This suggests a role of inflammation in the diabetogenic effects of risk factors contributing to the observed racial difference in diabetes incidence.


2019 ◽  
Vol 64 (No. 5) ◽  
pp. 204-208
Author(s):  
Z Ismail ◽  
AM Al-Majali ◽  
O Al-Rawashdeh ◽  
M Daradka ◽  
M Mohaffel

The objectives of this study were to determine the serum activities of the pancreatic enzymes amylase, lipase, trypsinogen 1 and trypsinogen 2, serum concentrations of total cholesterol, high density lipoprotein, low-density lipoprotein and triglycerides and serum inflammatory indicators, namely C-reactive protein and procalcitonin, in Holstein-Friesian dairy cows with left displacement of the abomasum (LDA). A total of 60 cows (30 LDA-affected and 30 healthy) were included in the study. Laboratory analyses were performed using commercially available ELISA kits and chemical reagents according to the manufacturers’ recommendations. There was a significant increase (P ≤ 0.05) in the activities of lipase, trypsinogen 1 and trypsinogen 2 in LDA-affected cows compared to healthy cows. Amylase concentrations, however, remained unchanged. The serum concentrations of total cholesterol and high-density lipoprotein were significantly (P ≤ 0.05) increased in LDA-affected cows while the concentrations of low-density lipoprotein and triglycerides were significantly (P ≤ 0.05) decreased compared to healthy cows. Procalcitonin and C-reactive protein concentrations were significantly (P ≤ 0.05) increased in LDA-affected cows compared to healthy cows. This study indicates that displacement of the abomasum may be associated with significant pathological effects in the pancreas that may affect cows in the post-operative period.


2007 ◽  
Vol 19 (1) ◽  
pp. 93-101 ◽  
Author(s):  
Non-Eleri Thomas ◽  
Stephen-Mark Cooper ◽  
Simon P. Williams ◽  
Julien S. Baker ◽  
Bruce Davies

The purpose of this study was to examine relationships between aerobic fitness (AF), fatness, and coronary-heart-disease (CHD) risk factors in 12- to 13-year-olds. The data were obtained from 208 schoolchildren (100 boys; 108 girls) ages 12.9 ± 0.3 years. Measurements included AF, indices of obesity, blood pressure, blood lipids and lipoproteins, fibrinogen, homocysteine, and C-reactive protein. An inverse relationship was found between AF and fatness (p < .05). Fatness was related to a greater number of CHD risk factors than fitness was (p < .05). Further analysis revealed fatness to be an independent predictor of triglyceride and blood-pressure levels (p < .05). Our findings indicate that, for young people, fatness rather than fitness is independently related to CHD risk factors.


2005 ◽  
Vol 109 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Hiren Divecha ◽  
Naveed Sattar ◽  
Ann Rumley ◽  
Lynne Cherry ◽  
Gordon D. O. Lowe ◽  
...  

Men with AS (ankylosing spondylitis) are at elevated risk for CHD (coronary heart disease) but information on risk factors is sparse. We compared a range of conventional and novel risk factors in men with AS in comparison with healthy controls and, in particular, determined the influence of systemic inflammation. Twenty-seven men with confirmed AS and 19 controls matched for age were recruited. None of the men was taking lipid-lowering therapy. Risk factors inclusive of plasma lipids, IL-6 (interleukin-6), CRP (C-reactive protein), vWF (von Willebrand factor), fibrin D-dimer, ICAM-1 (intercellular cell-adhesion molecule-1) and fibrinogen were measured, and blood pressure and BMI (body mass index) were determined by standard techniques. A high proportion (70%) of men with AS were smokers compared with 37% of controls (P=0.024). The AS patients also had a higher BMI. In analyses adjusted for BMI and smoking, men with AS had significantly higher IL-6 and CRP (approx. 9- and 6-fold elevated respectively; P<0.001), fibrinogen (P=0.013) and vWF (P=0.008). Total cholesterol and HDL-C (high-density lipoprotein cholesterol) were lower (P<0.05 and P=0.073 respectively) in AS and thus the ratio was not different. Pulse pressure was also significantly higher in AS (P=0.007). Notably, adjustment for IL-6 and CRP levels rendered all case-control risk factor differences, except pulse pressure, non-significant. In accordance with this finding, IL-6 correlated positively (r=0.74, P<0.001) with fibrinogen, but negatively (r=−0.46, P=0.016) with total cholesterol concentration. In conclusion, men with AS have perturbances in several CHD risk factors, which appear to be driven principally by systemic inflammatory mediators. Inflammation-driven atherogenesis potentially contributes to the excess CHD risk in AS.


2010 ◽  
Vol 28 (6) ◽  
pp. 333-342 ◽  
Author(s):  
Yanfang Zhao ◽  
Rui Wang ◽  
Xiuqiang Ma ◽  
Xiaoyan Yan ◽  
Zhansai Zhang ◽  
...  

C-reactive protein (CRP) levels vary remarkably with ethnic status. Its distribution and correlates should be investigated across diverse populations, and these were limited in a representative Chinese population. We investigated 3133 participants aged 18–80 years in Shanghai, which were sampled using a randomized, stratified, multi-stage sampling method. The distribution of CRP was highly skewed toward a lower level. The median CRP was 0.55 mg/L (0.61 mg/L in males, 0.51 mg/L in females). Participants living in urban region had higher CRP levels than those in rural region (0.67 vs. 0.46 mg/L). CRP levels showed significant correlation with traditional cardiovascular risk factors, and it was most strongly correlated with body mass index. Multivariate logistic regression analyses indicated that elevated CRP (being in the top 15 percentile of CRP; CRP ≥ 2.09 mg/L) was significantly associated with obesity, hypertension, diabetes, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, high triglycerides and cardiovascular disease history. In conclusion, the distribution of CRP in adult Chinese was comparable with that of many other Asian populations but different from that of Western populations. Metabolic impairment was associated with elevated CRP, and CRP levels should be interpreted in conjunction with the lipid profile.


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