E-cigarette Smoking (Vaping) and Markers of Vascular Wall Damage in Young Subjects without Cardiovascular Disease

Aim: to investigate the effect of nicotine-containing vapes in comparison with traditional tobacco smoking on markers of vascular wall damage: high sensitivity C-reactive protein (hsCRP), albuminuria (AU), and ankle-brachial index (ABI).Material and Methods: We examined 369 young subjects without cardiovascular diseases (age median 21 [20;21] years) (159 men and 210 women). The hsCRP levels in the serum were assessed by immunochromatographic express method. AU was investigated in daily urine by a quantitative reflex photometry. ABI was determined by plethysmography.Results: All subjects were divided into groups: non-smokers (n=196, 53.1%), smokers of traditional cigarettes (n=83, 22.5%) and smokers of nicotine-containing vapes (n=90, 24.4%). The groups did not differ in main anthropometric data. Median hsCRP levels in smokers (14.30 [11; 16.5] mg/l in tobacco-smokers and 13.15 [9.65; 17.5] mg/l in vapers) were significantly higher vs nonsmokers (3.0 [2; 5.6] mg/l). In tobacco-smokers (33.0 [21.5; 60] mg) and vape smokers (45.0 [20; 115] mg), the median AU was statistically significantly higher than in non-smokers (12.0 [10; 20] mg). ABI levels were significantly lower in the groups of tobacco smokers (0.98 [0.91; 0.99]) and vapers (0.85 [0.79; 0.93]) when compared with nonsmokers (1.125 [1.01; 1.18]), and the median ABI in vapers was lower than in tobacco smokers (p<0.001). In the group of tobacco smokers, the hsCRP level correlated with the smoker's index (rs=0.31, p<0.05), and AU (rs=0.54, p<0.05) and ABI (rs=-0.28, p<0.05) with a daily inhaled nicotine dose. In the group of vapers, CRP was associated with smoking experience (rs=0.338, p<0.05), AU with a daily inhaled nicotine dose (rs=0.79, p<0.05), and ABI with BMI (rs=-0.33, p<0.05), heart rate (rs=-0.24, p<0.05) and smoking experience (rs=-0.235, p<0.05). According to the results of multivariate regression analysis the hsCRP level was related with only the smoking experience (B=0.91±0.19, p=0.000005), AU level with the daily inhaled nicotine dose (B=1.59±0.7, p=0.0121) and smoking experience (B=3.07±1.23, p=0.0179), and ABI level with only smoking experience (B=-0.09±0.004, p=0.0419).Conclusion: In smokers, both traditional and vapers, the levels of hsCRP, AU are significantly higher, and the ABI is lower than in healthy young nonsmokers. The most significant influence on the level of hsCRP is exerted by the experience of tobacco and vape smoking; to the AU level – the experience of tobacco and vaping and the daily inhaled nicotine dose, and by the value of the ABI – the experience of vaping.

Comparison of High-Sensitive CRP, RDW, PLR and NLR between Patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure

Background: Chronic obstructive pulmonary disease (COPD) is a chronic systemic inflammation, which has similar signs and symptoms to chronic heart failure (CHF). Objective: To compare high-sensitive C-reactive protein (hsCRP) level and selected blood indices in patients with COPD and CHF. Methods: This prospective cross-sectional study (July 2019-July 2020) was conducted on patients aged 40-70 years old with a previous diagnosis of COPD, CHF, and cor pulmonale. They were divided into four groups: 1) patients with COPD, who were hospitalized due to exacerbation of dyspnea, 2) patients with CHF without a history of COPD, 3) patients with CHF and history of COPD (COPD+CHF), and finally 4) patients who had concomitant COPD and cor pulmonale condition. Spirometry, echocardiography, and six-minute walking test were performed. The hsCRP level was assessed at the beginning and end of hospital admission. Finally, RDW, neutrophil, lymphocyte, platelet counts, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were measured. Data were analyzed by SPSS software (α = 0.05). Results: In total, 140 patients were enrolled. The highest hsCRP level was observed in patients in the COPD+CHF group, and the lowest level was found in patients with CHF. Overall, a significant difference was observed in the hsCRP level at the beginning and the end of admission (P <0.0001). HsCRP had a positive correlation with the duration of hospital stay and a negative correlation with the results of the six-minute walking test. The lymphocyte counts and PLR had significant positive correlations with the six-minute walking test (R =0.38, P <0.0001 vs. R =0.325, P =0.001, respectively), and significant negative correlations with duration of hospital stay (R =-0.317, P <0.0001 vs. R =-0.380, P =0.001, respectively). At the admission, a significant difference in hsCRP was only observed comparing the COPD and cor pulmonale groups (OR =1.097, P =0.002). There were significant differences in the six-minute walking test comparing the COPD group with either of CHF or COPD+CHF groups. Significant differences were noted in the hospital stay duration comparing the COPD group with all other groups. Conclusion: The results of this study showed that lymphocyte, neutrophil, platelets counts, as well as RDW, NLR, and PLR indices, were not useful for differentiating COPD from CHF. However, the hsCRP level may help in differentiating COPD from patients with cor pulmonale.

Purslane (Portulaca oleracea) Ethanol Extract decreases hs-CRP levels and Total Score of Renal Tubular Degeneration in Rat Model of Gentamicine-Induced Renal Damage

Introduction: Injection of intraperitoneal gentamicin at a dose of 60 mg/kg BW intra-peritoneal in rats for 7 days has been shown to trigger renal tubular degeneration and increase in high sensitivity C-reactive protein (hs-CRP) level. The use of purslane (Portulaca oleracea) to reduce hs-CRP levels and total score of renal tubular degeneration has not been reported.Objective: to determine the effect of purslane ethanol extract on hs-CRP levels and renal tubular degeneration score in gentamicin induced-renal damage in rats.Methods: This was a study using posttest only control group design. Twentyfive male Wistar rats aged 8-12 weeks, weighed 150-200 grams were allocated into 5 groups: normal (Nor-G), without treatment; negative (Neg-G), gentamicin (60 mg/kg BW), intraperitoneally; P-200; P-300 ; P-400 (gentamicin plus purslane extract at a dose of 200, 300, and 400 respectively) for 7 days. The hs-CRP was evaluated using the ELISA method. Total score of renal tubular degeneration was evaluated using modified score of Sarjadi.Results: there was a significant difference in mean hsCRP level and total score of renal tubular degeneration between groups (p <0.05). Posthoc analysis showed that hsCRP level and total score group of P-200, P-300 and P-400 were significantly lower than those of Neg-G, p <0.05. Meanwhile, the levels of hsCRP and total score of renal tubular degeneration in P-200, P-300, P-400, and Nor-G groups were not significantly different (p> 0.05).Conclusion: the administration of purslane ethanol extract at doses of 200, 300, and 400 mg/kg BW for 7 days improve hs-CRP level and total score of tubular degeneration similar to normal.

Abstract 14450: Association of Trajectory of High Sensitivity C-reactive Protein and Incident Heart Failure in African Americans: The Jackson Heart Study

Introduction: Elevation in the inflammatory marker high sensitivity C-reactive protein (hsCRP) is associated with worse outcomes in patients with heart failure (HF). We aimed to determine if baseline or trajectory of hsCRP levels over time predict incident HF hospitalization. Methods: Jackson Heart Study (JHS) participants’ (n=4203 African Americans) hsCRP levels were measured over 3 visits (visit 1: 2000 to 2004; visit 2: 2005 to 2008; visit 3: 2009 to 2013). We assessed the association of a single hsCRP level measurement at baseline (visit 1) with incident HF hospitalization using Cox proportional hazard models. Furthermore, we assessed the association of trajectory of hsCRP over repeated measurements (visit 1-3) with incident HF using a joint model, which incorporates estimated hsCRP from a linear mixed effects model into a Cox hazards model to predict incident HF hospitalization while incorporating trajectory of hsCRP over visits. All hazard ratios (HR) are presented as an increase in hsCRP by 1 standard deviation on a Log 2 scale. Results: At baseline, mean age of participants was 55±13 years, 63.4% were women, and mean hsCRP level was 0.5±0.7 mg/dl. Over a median follow-up of 12 years, 353 (8.4%) participants were hospitalized with incident HF. After adjustment for covariates, baseline hsCRP was not associated with increased risk of incident HF hospitalization (Table, p>0.05). However, increases in hsCRP levels on follow-up were associated with a significantly increased risk of incident HF hospitalization (Table, p<0.05). Conclusions: While an elevated hsCRP level at one time point may not be associated with incident HF, the increasing trajectory of change in hsCRP over time is predictive of increased risk for incident HF hospitalization in African Americans. These data support the role of increased inflammatory status in the development of heart failure.

Higher level of high sensitivity C-reactive protein is associated with more fibrocalcific plaque and longer lesion in patients with acute coronary syndrome

Background The association between the level of high sensitivity C-reactive protein (hsCRP) and coronary plaque characteristics in patients with acute coronary syndrome (ACS) remains to be elucidated. Purpose To clarify the morphological characteristics of culprit lesion in patients with ACS according to the hsCRP levels using optical coherence tomography (OCT). Methods A total of 215 consecutive patients with ACS, who underwent OCT imaging of culprit lesions were included. The patients were classified into either the higher hsCRP group (hsCRP ≥0.14 mg/dL, n=108) or the lower hsCRP group (hsCRP &lt;0.14 mg/dL, n=107) according to the median preprocedural hsCRP level. The morphological characteristics of culprit lesion assessed by OCT were compared between the two groups. Results The higher hsCRP group had higher prevalence of insulin therapy (14 vs. 6%, p=0.037) and current smoker than the lower hsCRP group (37 vs. 18%, p=0.002). The prevalence of long lesion (≥25 mm, 67 vs. 53%, p=0.041) and fibrocalcific plaque (53 vs. 33%, p=0.003) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Figure). On the other hand, the prevalence of plaque rupture (36 vs. 46%, p=0.174) and lipid-rich plaque (47 vs. 64%, p=0.011) was rather lower in the higher hsCRP group than in the lower hsCRP group (Figure). In a multivariate analysis, fibrocalcific plaque (odds ratio [OR]: 2.098, 95% confidence interval [CI]: 1.125–3.913, p=0.019), lesion length (mm, OR: 1.036, 95% CI: 1.010–1.061, p=0.004) and current smoker (OR: 2.757, 95% CI: 1.388–5.476, p=0.003) was independently associated with higher hsCRP level. Conclusions ACS patients with high hsCRP levels had more fibrocalcific plaque and longer lesion than those with low hsCRP levels. The association between high hsCRP levels and vulnerable characteristics of culprit plaque was not demonstrated. Funding Acknowledgement Type of funding source: None

Associations of Serum Pepsinogens and Helicobacter Pylori Infection with High-Sensitivity C-Reactive Protein in Medical Examination Population

Objective This study aimed to clarify the distribution characteristics of serum pepsinogen (PG) and Helicobacter pylori in the medical examination population and to explore the relationships of PG level and H. pylori infection status with the high-sensitivity C-reactive protein (hsCRP) level and their significance in health examination. Methods We detected H. pylori infection by C13 urea breath test, the serum pepsinogen I (PGI) and pepsinogen II (PGII) contents were measured by chemiluminescence microparticle immunoassay, and the PGI/PGII ratio was calculated. In addition, the serum hsCRP level was determined by the Abbott C16000 automatic biochemical analyzer. Results The PGI and hsCRP levels were significantly higher in men than in women, and the PGII level was slightly higher in men than in women (both P &lt;.05). The PGI, PGII, and hsCRP levels were positively correlated with age (r = 0.210, 0.287, and 0.133, respectively; P &lt;.05), whereas the PGI/PGII ratio was negatively correlated with age (r = –0.190; P &lt;.05). The positive H. pylori infection rate was 30.2% among the patients in this study; H. pylori infection was not related to sex (P &gt;.05), and the difference in age stratification was not statistically significant (P &gt;.05). The abnormal PGI/PGII ratio in the medical examination population was not correlated with sex (P &gt;.05). In the H. pylori positive infection group, the proportion of PGI/PGII ratio &lt;3, the PGI and PGII levels were significantly higher than those in the H. pylori negative infection group, and the PGI/PGII ratio was significantly lower than that in the negative group (both P &lt;.05). The hsCRP level was not associated with H. pylori infection (P &gt;.05), and it was significantly higher in the PGI/PGII ratio &lt;3 group than in the PGI/PGII ratio ≥3 group (P &lt;.05). Conclusion The PGI and PGII levels and the PGI/PGII ratio are correlated with H. pylori infection. The abnormal PGI/PGII ratio is closely related to H. pylori infection and hsCRP level. Therefore, H. pylori infection status and hsCRP level should be considered when determining atrophic gastritis by the PGI/PGII ratio.

Clinical characteristics and predictors of pneumonia in patients presenting fever or respiratory symptoms with normal or low leukocyte counts: a retrospective study

Background Many patients went to the hospital presenting with acute fever, or respiratory symptoms, most of whom have a normal or low leukocyte counts. The aim of this study was to investigate the clinical characteristics and predictors of pneumonia in those patients. Methods In this retrospective study, adult patients (≥ 18 years old) presenting with acute fever or respiratory symptoms with normal or low leukocyte counts (≤ 9.5 × 109/L) in Peking Union Medical College Hospital between 26 January 2020 and 10 March 2020 were included. Patients were categorized into groups with pneumonia or upper respiratory tract infection (URTI) according to chest CT scans. Logistic regression was used to explore predictors of pneumonia. Results A total of 195 patients were included, 63 of whom were diagnosed with pneumonia. The median maximum body temperature was 38.5 °C (38.0-38.8 °C) in patients with pneumonia and 37.5 °C (37.4–37.8 °C) in the other group. There was a significant difference in high-sensitivity C-reactive protein (hsCRP) levels between the two groups (0.21 (0-3.74) versus 33.4 (15.5–75.5) mg/L, p < 0.001). Multivariable regression showed that the predictive values of pneumonia were older age (OR 1.06, 95% CI 1.02–1.10, p = 0.004), cough (OR 0.18, 95%CI 0.06–0.56; p = 0.003), higher temperature (OR 3.36, 95%CI 1.16–9.71; p = 0.025) and higher hsCRP level (OR 1.05, 95%CI 1.02–1.09; p = 0.003). The optimal cutoff values based on the ROC curve analysis were a temperature of 37.8 °C and a hsCRP level of 1.64 mg/L. Conclusions Patients with older age, cough, higher temperature and higher hsCRP level were more inclined to have pneumonia. Temperatures higher than 37.8 °C were a potential predictor of pneumonia in patients with normal or low leukocyte counts in the early stage. However, a hsCRP level less than 1.64 mg/L could rule out most cases of pneumonia.

Layer‐specific strain and dyssynchrony index alteration in new-onset systemic lupus erythematosus patients without cardiac symptom

Background Layer-specific speckle-tracking echocardiography (STE) is a noninvasive approach assessing subclinical left ventricular (LV) dysfunction. We aimed to investigate: (I) layer‐specific strain and dyssynchrony index alteration; (II) disease parameters associated with layer-specific STE change; (III) effects of hydroxychloroquine (HCQ) therapy on layer-specific STE parameters in drug-naïve patients with new-onset systemic lupus erythematosus (SLE) without cardiac symptoms. Methods 35 drug-naïve patients with new-onset SLE and 25 age-and-sex-matched healthy controls were enrolled. All individuals received both conventional echocardiographic and two-dimensional STE assessment. Layer-specific global longitudinal strain (GLS), global circumferential strain (GCS) and peak systolic dispersion (PSD) were acquired in layer-specific STE. The effect of HCQ monotherapy on GLS parameters and PSD was assessed in 7 SLE patients with stable disease. Results All patients had normal left ventricular ejection fraction (LVEF). Conventional echocardiographic parameters were comparable between patients and controls. Decreased layer-specific GLS and elevated PSD were observed in SLE patients. In contrast, there’s no difference of layer-specific GCS at the basal level, papillary muscle level and apical level between patients and controls. More severely impaired GLS was observed in patients with higher disease activity, high-risk aPL profile or renal involvement. PSD increased in patients with higher disease activity or high-risk aPL profile. Correlational analysis showed that GLS at three layers and PSD correlated with high-sensitivity CRP (hsCRP) levels. PSD correlated with epicardial GLS, when treating hsCRP level, renal involvement, profile of aPL and disease activity as control variables. Multivariate regression showed hsCRP level and epicardial GLS are the predictors of layer-specific GLS impairment and elevated PSD, respectively. No change of GLS at three layers or PSD was observed in the first 6 months of HCQ treatment, compared with baseline. During the second 6 months of HCQ treatment, increase of endocardial GLS and whole layer GLS, and decrease of PSD were detected. There was no change of epicardial GLS during follow-up. Conclusion Drug-naïve patients with new-onset SLE, even having normal LVEF, are likely to have subclinical GLS impairment and LV dyssynchrony. SLE-related risk factors are associated with these dysfunctions. Continuous use of HCQ may provide beneficial effects to the silent cardiac impairment.

MON-099 The Association Between C-Reactive Protein, Metabolic Syndrome, and Pre-Diabetes in Korean Children and Adolescents

Objective: Cardiovascular disease (CVD) is a leading cause of death worldwide, including in Korea. In adults, the risk for CVD is increased approximately three-fold in subjects with metabolic syndrome (MetS), and the hazard ratio for subjects with MetS has been reported as 1.37 for mortality from CVD after adjustment for other confounders. Furthermore, MetS in childhood predicts adult MetS and T2DM 25 to 30 years later. Because MetS is a state of chronic low-grade inflammation, measurements of the circulating levels of the inflammatory molecules might provide diagnostic and therapeutic approaches to modulate or alter disease progression. High sensitivity C-reactive protein (hsCRP), a biomarker of inflammation, has emerged as an independent predictor of CVD and T2DM development. The aim of this paper is to evaluate the association between hsCRP and MetS and its components in Korean children and adolescents. Methods: We performed a cross-sectional analysis using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2017. We analyzed the data of 1,247 subjects (633 males, 14.2 ± 2.7 years) from the KNHANES 2016–2017. MetS were defined by the modified NCEP-ATP III criteria. Results: Among the 1,247 subjects (mean age: 14.2 ± 2.7 years), the prevalence of MetS was 5.8% (7.0% in male subjects and 4.6% in female subjects; p = 0.070). The mean hsCRP level was 0.861 ± 1.567 mg/l (median and interquartile range: 0.370 and 0.430mg/l). Subjects with MetS had higher hsCRP levels than subjects without MetS (geometric mean: 1.08 vs. 0.46 mg/l, p &lt; 0.001). The prevalence of MetS in the lowest, second, third, and highest hsCRP quartiles were 1.8%, 2.4%, 3.5%, and 15.2%, respectively. Compared to the lowest quartile, the odds ratio (OR) for having MetS in the highest quartile was 8.414 (3.272–21.638), adjusting for age and sex. The OR for having abdominal obesity and low HDL-C in the highest quartile were 9.657 (4.818–19.355) and 2.408 (1.286–4.510), adjusting for age, sex, and other components of the MetS. Additionally, the OR for having pre-diabetes (HbA1c ≥ 5.7%) in the highest quartile was 2.061 (1.097–3.870). Conclusion: Serum hsCRP level is positively associated with MetS and pre-diabetes in Korean children and adolescents.