The Predictive Value of hs-C-Reactive Protein Is Based on the Presence of Antiphospholipid Antibodies.

Abstract High-sensitive C-reactive protein (hs-CRP) is a marker of inflammation which has been shown in several prospective studies to predict independently myocardial infarction, stroke or peripheral artery disease. Patients with antiphospholipid antibodies (aPL) are at increased risk of recurrent thromboembolic events but the possibility to predict such risk seems rather limited. Recently, similarities were found in the pathology of thrombosis between elevated levels of hs-CRP and the presence of aPL.We studied the predictive role of hs-CRP levels in patients with the presence of aPL of a cohort of patients with neurological manifestations compared to those where aPL could be excluded. Patients A follow-up investigation was done in 55 aPL-positive and 61 aPL -negative, sex- and age matched patients of the same cohort of patients with acute manifestations of neurological diseases. Hs-CRP levels were measured in all patients at enrollment and were related to the outcome of the patients after a median time of 32 months. Methods Lupus anticoagulants were detected according to the SSC of the ISTH. Anticardiolipin tests were performed by a ß2-glycoprotein I-dependent enzyme-linked immunsorbent assay (Pharmacia ELISA). Hs-CRP was measured by latex enhanced turbidometry (dimension RXL, Dade Behring). Results Cerebral infarctions and transient ischemic attacks were the most common cerebral manifestations of the patients. In APS patients elevated levels of hs-CRP could be measured significantly more frequently than in patients where aPL could be excluded (44 % vs. 16 %, p<0.005). The rate of recurrences or severe residual symptoms was higher in patients with aPL (45 %) compared to 32 % in aPL-negative patients. In non APS patients hs-CRP levels were not associated to the occurrence of future neurological events. In patients with aPL elevated levels of hs-CRP were highly associated to an increased rate of recurrent or residual symptoms (OR, 12.5; 95 % CI, 3.72 to 41.94) and not related to other risk factors, except of smoking (p<0.05). Conclusion Elevated levels of hs-CRP were associated to the presence of aPL and related to the risk of recurrences in these patients but not in patients where the presence of aPL could be excluded. In patients with APS elevated levels of hs-CRP may identify a group of patients at high risk of recurrent or residual neurological symptoms who may benefit from a more careful follow-up and antithrombotic therapy.

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P3645Prognosis in relation to high-sensitivity C-reactive protein levels in patients with non-obstructive coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/ehz745.0502 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H W Zhang ◽

Y X Cao ◽

J L Jin ◽

Y L Guo ◽

Y Gao ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Obstructive Coronary Artery Disease ◽

High Sensitivity ◽

C Reactive Protein ◽

Development Fund ◽

Reactive Protein ◽

Increased Risk ◽

Hs Crp ◽

Artery Disease

Abstract Background It has been reported that coronary artery disease (CAD) is characterized by inflammation and non-obstructive CAD (NOCAD) increases the risk of cardiovascular events (CVEs) compared with ones with normal or near-normal coronary arteries (NNCA), even is similar to obstructive CAD (OCAD). We hypothesized that elevated high-sensitivity C-reactive protein (hs-CRP) may be linked to CVEs in those patients with NOCAD. Purpose To investigate the predictive role of hs-CRP in patients with NOCAD. Methods Of 7,746 consecutive patients with angina-like chest pain admissions, 4,662 eligible patients were enrolled who received coronary artery angiography (CAG) and followed up for the CVEs comprising all-cause mortality, myocardial infarction, stroke and late revascularization. According to the results of CAG, the patients were classified as NNCA group (<20% stenosis, n=698, 15.0%), NOCAD group (20–49% stenosis, n=639, 14.3%), and OCAD group (≥50% stenosis, n=3325, 70.7%). They were further subdivided into 3 groups according to baseline hs-CRP levels (<1, 1–3 and >3 mg/L). Proportional hazards models were used to assess the risk of CVEs in all patients enrolled. Results A total of 338 patients (7.3%) experienced CVEs during an average of 13403 person-years follow-up. Patients with NOCAD and OCAD had higher rates of CVEs compared to those with NNCA (p<0.05, respectively). In Cox's models after adjustment of confounders, the risk of CVEs elevated with the increasing degrees of CAD with hazard ratio of 2.01 [95% confidence interval (95% CI): 1.07–3.79, p=0.03] for patients with NOCAD and 2.81 (95% CI: 1.60–4.93, p<0.001) for patients with OCAD compared with the NNCA group. Moreover, elevated hs-CRP levels were associated with the severity of coronary lesions and an elevated increased risk of CVEs in patients with NOCAD and OCAD compared those with NNCA (p<0.05, respectively). Conclusions Patients with NOCAD had indeed worse outcomes and hs-CRP levels were positively in relation to the CVEs in those with NOCAD, which may help to the risk assessment in ones with NOCAD. Acknowledgement/Funding This study was partly supported by Capital Health Development Fund (201614035) and CAMS Innovation Fund for Medical Sciences (2016-I2M-1-011) awarded

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High-sensitivity C reactive protein and risk of cardiovascular disease in China-CVD study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2018-211433 ◽

2018 ◽

Vol 73 (2) ◽

pp. 188-192 ◽

Cited By ~ 3

Author(s):

Ying Dong ◽

Xin Wang ◽

Linfeng Zhang ◽

Zuo Chen ◽

Congyi Zheng ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chinese Population ◽

High Sensitivity ◽

C Reactive Protein ◽

Middle Aged ◽

Reactive Protein ◽

Net Reclassification Improvement ◽

Increased Risk ◽

Hs Crp

BackgroundThis study aimed to assess the association of high sensitivity C-reactive protein (hs-CRP) with cardiovascular disease (CVD) in middle-aged Chinese population.MethodsThe baseline was collected 2009–2010, and follow-up was conducted in 2016–2017. Data of hs-CRP were from baseline examination and re-examination in 2016–2017 using transmission turbidimetry with a measurement range of 0–42 000. The primary outcome was CVD including coronary heart disease events and stroke events.ResultsAmong 8688 participants free from CVD (at baseline, mean age, 50.1 years, 3897 were males), there were 189 CVD events, occurred during a median follow-up of 6.34 years (54 685 person-years at risk). From the Kaplan-Meier curve, we found that there was a progressive increase in CVD event rates by hs-CRP tertiles (log-rank test, p<0.001). Baseline hs-CRP was linearly associated with CVD (p for trend=0.015) even after adjusting for known CVD risk factors. Furthermore, the net reclassification improvement when hs-CRP was added to a model based on traditional factors was 7.85% for CVD (p=0.003). In addition, the correlation between change of hs-CRP and CVD was conducted in a subgroup (n=4778). However, we did not find the correlation between hs-CRP change and CVD (correlation coefficient: −0.003, p=0.846).ConclusionsIn the middle-aged Chinese population, hs-CRP was associated with increased risk of developing CVD. Although there was no correlation between hs-CRP change and CVD, the level of hs-CRP was higher at follow-up than baseline even among those with CVD. More attention should be given to those with higher level of hs-CRP for CVD prevention.

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C-reactive protein as a marker of progression of carotid atherosclerosis in subjects with type 2 diabetes mellitus

VASA ◽

10.1024/0301-1526/a000614 ◽

2017 ◽

Vol 46 (3) ◽

pp. 187-192 ◽

Cited By ~ 7

Author(s):

Aleš Pleskovič ◽

Marija Šantl Letonja ◽

Andreja Cokan Vujkovac ◽

Jovana Nikolajević Starčević ◽

Katarina Gazdikova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Carotid Atherosclerosis ◽

Inflammatory Marker ◽

Progression Rate ◽

C Reactive Protein ◽

Reactive Protein ◽

Hs Crp ◽

Unstable Plaques

Abstract. Background: This prospective study was designed to evaluate the effect of inflammatory markers on the presence and progression of subclinical markers of carotid atherosclerosis in a 3.8-year follow-up period in patients with type 2 diabetes mellitus (T2DM). Patients and methods: A total of 595 subjects with T2DM were enrolled. Subclinical markers of carotid atherosclerosis (carotid intima media thickness (CIMT), plaque thickness, and plaques presence) were assessed with ultrasound at the time of recruitment and again after 3.8 years. Subjects with T2DM were divided into 2 groups according to the plasma high sensitive C-reactive protein (hs-CRP) levels (subjects with hs-CRP ≥ 2 mg/L and subjects with hs-CRP below 2 mg/L). Results: Subjects with T2DM and hs-CRP levels ≥ 2 mg/L had higher CIMT in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L, and higher incidence of plaques/unstable plaques in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L. Multivariate logistic regression analysis found the association between the HDL cholesterol level and presence of plaques, whereas the inflammatory marker hs-CRP was not associated with subclinical markers of progression of carotid atherosclerosis. Multiple linear regression analysis found the association between the hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up. Conclusions: We demonstrated an association between the inflammatory marker hs-CRP and either CIMT or incidence of plaques/unstable plaques at the time of recruitment in Caucasians with T2DM. Moreover, we found the association between hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up in subjects with T2DM.

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The Predictive Role of Tooth Extractions, Oral Infections, and hs-C-Reactive Protein for Mortality in Individuals with and without Diabetes: A Prospective Cohort Study of a 12 1/2-Year Follow-Up

Journal of Diabetes Research ◽

10.1155/2017/9590740 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Lise Lund Håheim ◽

Kjersti S. Rønningen ◽

Morten Enersen ◽

Ingar Olsen

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

C Reactive Protein ◽

Oral Infections ◽

Reactive Protein ◽

Predictive Role ◽

Hs Crp ◽

Tooth Extractions

The predictive role of high-sensitivity C-reactive protein (hs-CRP), number of tooth extractions, and oral infections for mortality in people with and without diabetes is unclear. This prospective cohort study is a 12 1/2-year follow-up of the Oslo II study, a health survey in 2000. In all, 12,764 men were invited. Health information was retrieved from 6434 elderly men through questionnaire information, serum measurements, and anthropometric and blood pressure measurements. Diabetes was reported by 425 men. Distinct differences were observed in baseline characteristics in individuals with and without diabetes. In the diabetes group, age and hs-CRP were statistically significant whereas in the nondiabetes group, age, hs-CRP, number of tooth extractions, tooth extractions for infections and oral infections combined, nonfasting glucose, systolic blood pressure, total cholesterol, regular alcohol drinking, daily smoking, and level of education were independent risk factors. The number of tooth extractions <5 was inversely related whereas more extractions increased the risk. Multivariate analyses showed that hs-CRP was a significant predictor in persons with diabetes and tooth extractions and oral infections combined; the number of teeth extracted and hs-CRP were for persons without diabetes. Infection and inflammation were associated with mortality in individuals both with and without diabetes.

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Perioperative changes of response to antiplatelet medication in vascular surgery patients

PLoS ONE ◽

10.1371/journal.pone.0244330 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244330

Author(s):

Thomas Hummel ◽

Saskia Hannah Meves ◽

Andreas Breuer-Kaiser ◽

Jan-Ole Düsterwald ◽

Dominic Mühlberger ◽

...

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Vascular Surgery ◽

Reactive Protein ◽

Antiplatelet Medication ◽

Impedance Aggregometry ◽

Increased Risk ◽

Potential Risk Factors ◽

Artery Disease

Introduction Reduced antiplatelet activity of aspirin (ALR) or clopidogrel (CLR) is associated with an increased risk of thromboembolic events. The reported prevalence data for low-responders vary widely and there have been few investigations in vascular surgery patients even though they are at high risk for thromb-embolic complications. The aim of this prospective observational monocentric study was to elucidate possible changes in ALR or CLR after common vascular procedures. Methods Activity of aspirin and clopidogrel was measured by impedance aggregometry using a multiple electrode aggregometer (Multiplate®). Possible risk factors for ALR or CLR were identified by demographical, clinical data and laboratory parameters. In addition, a follow-up aggregometry was performed after completion of the vascular procedure to identify changes in antiplatelet response. Results A total of 176 patients taking antiplatelet medications aspirin and/or clopidogrel with peripheral artery disease (PAD) and/or carotid stenosis (CS) were included in the study. The prevalence of ALR was 13.1% and the prevalence of CLR was 32% in the aggregometry before vascular treatment. Potential risk factors identified in the aspirin group were concomitant insulin medication (p = 0.0006) and elevated C-reactive protein (CRP) (p = 0.0021). The overall ALR increased significantly postoperatively to 27.5% (p = 0.0006); however, there was no significant change in CLR that was detected. In a subgroup analysis elevation of the platelet count was associated with a post-procedure increase of ALR incidence. Conclusion The incidence of ALR in vascular surgery patients increases after vascular procedures. An elevated platelet count was detected as a risk factor. Further studies are necessary to analyse this potential influence on patency rates of vascular reconstructions.

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A prospective follow-up study of the relationship between high-sensitivity C-reactive protein and primary liver cancer

BMC Cancer ◽

10.1186/s12885-020-07665-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sarah Tan Siyin ◽

Tong Liu ◽

Wenqiang Li ◽

Nan Yao ◽

Guoshuai Xu ◽

...

Keyword(s):

Liver Cancer ◽

Regression Models ◽

Primary Liver Cancer ◽

High Sensitivity ◽

C Reactive Protein ◽

Reactive Protein ◽

Hs Crp ◽

The Relationship ◽

New Onset

Abstract Background Competing risk method has not been used in a large-scale prospective study to investigate whether increased levels of high-sensitivity C-reactive protein (hs-CRP) elevate the risk of primary liver cancer (PLC). Our study aims to prospectively investigate the relationship between hs-CRP and new-onset PLC. Methods and results Ninety-five thousand seven hundred fifty-nine participants without the diagnosis of PLC, and who had their demographic characteristics and biochemical parameters recorded, were analyzed from the Kailuan Cohort study. Cox proportional hazards regression models and competing risk regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of PLC. During a median follow-up of 11.07 years, 357 incidental PLC cases were identified over a total of 1,035,039 person-years. The multivariable HRs (95%CI) for the association of hs-CRP of 1–3 mg/L group and hs-CRP>3 mg/L with PLC were 1.07(0.82 ~ 1.38), 1.51(1.15 ~ 1.98) in a Cox proportional hazard regression analysis adjusted for other potential confounders. In the cause-specific hazard model, the multivariable HRs (95%CI) for the association of hs-CRP of 1–3 mg/L group and hs-CRP>3 mg/L with PLC were 1.06(0.81 ~ 1.40), 1.50(1.14 ~ 1.99). Similar results were also observed in the sub-distribution hazard function model with corresponding multivariate HRs (95%CI) of 1.05(0.80 ~ 1.40), 1.49(1.13 ~ 1.98) in hs-CRP of 1–3 mg/L group and hs-CRP>3 mg/L group, respectively. Conclusions This prospective study found a significant association of higher levels of hs-CRP with new-onset PLC. The main clinical implications would be an increased awareness of hs-CRP and its correlation to the risk of PLC. This study should be a steppingstone to further research on chronic inflammation and PLC. Trial registration Registration number:ChiCTR–TNRC–11001489.

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Antibodies against Malondialdehyde in Haemodialysis Patients and Its Association with Clinical Outcomes: Differences between Subclasses and Isotypes

Journal of Clinical Medicine ◽

10.3390/jcm9030753 ◽

2020 ◽

Vol 9 (3) ◽

pp. 753

Author(s):

Shailesh Kumar Samal ◽

Abdul Rashid Qureshi ◽

Mizanur Rahman ◽

Peter Stenvinkel ◽

Johan Frostegård

Keyword(s):

Significant Risk ◽

Premature Death ◽

C Reactive Protein ◽

Reactive Protein ◽

Multivariate Risk ◽

Increased Risk ◽

All Cause Mortality ◽

Low Levels ◽

Antibody Levels

Patients on haemodialysis (HD-patients) have an increased risk of premature death. Low levels of IgM antibodies against malondialdehyde (anti-MDA) are associated with increased risk of cardiovascular disease (CVD) with underlying potential mechanisms described. Here, we studied subclasses and isotypes of anti-MDA in 210 HD-patients with mortality as outcome (56% men, median age 66, Interquartile range (IQR) 51–74 years, vintage time 29 (15–58) months, mean follow up period of 41 (20–60)months). Patients were also divided into inflamed c-reactive protein (CRP >5.6 mg/mL) and non-inflamed. Antibody levels were measured by ELISA. In multivariate risk analysis, patients in low tertile of IgM anti-MDA sub-distribution hazard ratio (sHR 0.54); 95% confidence interval (CI: 0.34–0.89) inversely and significantly associated with all-cause mortality after five years, after adjusting for confounders. Low tertile of IgG (sHR 0.48, 95%CI: 0.25–0.90, p = 0.02) and IgG1 (sHR 0.50, CI: 0.24–1.04, p = 0.06) was associated low mortality among non-inflamed patients. In contrast, anti-MDA IgG2 among inflamed patients was significantly associated with increased mortality, IgG2(sHR 2.33, CI: 1.16–4.68, p = 0.01). IgM anti-MDA was a novel biomarker among HD-patients with low levels being associated with mortality, while low levels of IgG and IgG1 but not IgA anti-MDA were associated with mortality only among non-inflamed patients. IgG2 anti-MDA was a significant risk marker among inflamed patients, which could be related to infection.

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The Cumulative Exposure to High-Sensitivity C-Reactive Protein Predicts the Risk of Chronic Kidney Diseases

Kidney & Blood Pressure Research ◽

10.1159/000504251 ◽

2019 ◽

Vol 45 (1) ◽

pp. 84-94

Author(s):

Jingli Gao ◽

Aitian Wang ◽

Xiaolan Li ◽

Junjuan Li ◽

Hualing Zhao ◽

...

Keyword(s):

Kidney Diseases ◽

High Sensitivity ◽

Cox Proportional Hazards ◽

Exposed Group ◽

Cumulative Exposure ◽

C Reactive Protein ◽

Chronic Kidney Diseases ◽

Reactive Protein ◽

Increased Risk ◽

Hs Crp

Background and Objectives: This study was to characterize the association of cumulative exposure to increased high-sensitivity C-reactive protein (hs-CRP) with chronic kidney diseases (CKD). Methods: We included 35,194 participants with hs-CRP measured at three examinations in 2006, 2008, 2010. Participants were classiﬁed into nonexposed group (hs-CRP <3.0 mg/L in all 3 examinations), 1-exposed group (hs-CRP ≥3.0 mg/L in 1 of the 3 examinations), 2-exposed group (hs-CRP ≥3.0 mg/L in 2 of the 3 examinations), and 3-exposed group (hs-CRP ≥3.0 mg/L in 3 examinations). Cox proportional hazards models were used to assess the association of cumulative hs-CRP with incident CKD. CKD includes an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or urinary protein positive. Results: The study showed the risk of CKD as the number of years of exposure to hs-CRP increases. Participants in 3-exposed group had significantly increased CKD risk with hazard ratio (HR) (95% confidence interval, CI) of 1.70 (1.49–1.93), in comparison with 1.47 (1.34–1.62) for participants in the 2-exposed group, and 1.08 (1.00–1.16) for those in the 1-exposed group (p < 0.01); meanwhile, the similar and significant associations were also observed for eGFR <60 mL/min/1.73 m2, proteinuria positive, in participants of the 3-exposed group in comparison with the nonexposed group, with respective HRs (95% CI) of 1.27 (1.01–1.58) and 2.27 (1.87–2.76). Conclusions: Cumulative exposure to hs-CRP was associated with a subsequent increased risk of CKD and was of great value to risk prediction.

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Peripheral Inflammatory Biomarkers for Myocardial Infarction Risk: A Prospective Community-Based Study

Clinical Chemistry ◽

10.1373/clinchem.2016.260828 ◽

2017 ◽

Vol 63 (3) ◽

pp. 663-672 ◽

Cited By ~ 18

Author(s):

Zhijun Wu ◽

Zhe Huang ◽

Wei Jin ◽

Eric B Rimm ◽

Alice H Lichtenstein ◽

...

Keyword(s):

Myocardial Infarction ◽

Repeated Measures ◽

High Sensitivity ◽

Community Based ◽

Reactive Protein ◽

Inflammatory Status ◽

Increased Risk ◽

Hs Crp ◽

Wbc Count

Abstract BACKGROUND Most previous studies regarding chronic inflammation and risk of myocardial infarction (MI) have lacked repeated measures of high-sensitivity C-reactive protein (hs-CRP) and/or white blood cell (WBC) count over time. We examined whether cumulative average and longitudinal changes in these biomarkers were associated with subsequent MI risk. METHODS In this prospective, community-based study, we included 82544 Chinese participants [66796 men and 15748 women; mean (SD) age 55.1 (9.86) y] without prior cardiovascular diseases or cancer at baseline (2006–2007). hs-CRP, WBC and other clinical covariates were assessed at baseline and every 2 years during follow-up. RESULTS During 6 years of follow-up (2006–2012), we documented 714 incident MI cases. Higher baseline and cumulative average concentrations of hs-CRP and/or WBC were consistently associated with increased risk of MI (Ptrend <0.001 for both). Longitudinal increase in hs-CRP (Ptrend <0.001), but not WBC, was also associated with a higher future risk of MI, after adjustment for their baseline values and other covariates. Each 1-mg/L increment per year in hs-CRP was associated with a 9.3% increase in risk for future MI [hazard ratio (HR) = 1.09, 95% CI, 1.03; 1.17]. Participants with high-grade inflammatory status (hs-CRP ≥10 mg/L and WBC ≥10 × 109/L) had a higher risk of MI occurring <3 months after hs-CRP/WBC assessments vs those with hs-CRP <0.5 mg/L and WBC <5 × 109/L (HR = 6.64; 95% CI, 1.49–29.6), as compared with MI occurring ≥4 years (HR = 2.95; 95% CI, 0.90, 9.65). CONCLUSIONS Plasma hs-CRP concentration and WBC predicted MI risk. Longitudinal increase in hs-CRP was also associated with a higher risk of MI.

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