Objectives Among patients with severe aortic stenosis (AS), we investigated the associations of N-terminal pro-natriuretic peptide (NT-proBNP), high-sensitive troponin T (hsTnT), and high-sensitive C-reactive protein (hs-CRP) with 3-year mortality and major adverse cardiovascular events (MACE) during 1 year. Methods This observational cohort study prospectively enrolled 442 patients with severe AS who were referred for evaluation of possible valve replacement. Clinical data was recorded before the decision of whether to operate was made. We studied the prognostic value of assessing biomarkers by serum levels, and tested associations of NT-proBNP, hsTnT, and hs-CRP with clinical outcomes (3-year all-cause mortality and risk of MACE in the year following study inclusion) using adjusted multivariable analysis. Results Elevated serum levels of these biomarkers at baseline evaluation were associated with increased all-cause 3-year mortality regardless of treatment assignment. Adjusted analysis showed that none of the studied biomarkers (NT-proBNP, hsTnT or hs-CRP) or any other covariates were associated with 3-year all-cause mortality following surgical aortic valve replacement (SAVR). However, adjusted analyses showed that hsTnT (HR, 1.51; 95% CI, 1.11-2.05; P = 0.008) and left ventricular ejection fraction (HR 0.97; 95% CI 0.94-0.97, P = 0.043) was associated with MACE for operated patients. Conclusions Whereas NT-proBNP, hsTnT and hs-CRP had no independently prognostic value in relation to all-cause mortality following SAVR, hsTnT was independently associated with MACE following operation. The use of these clinically available biomarkers, in particular hsTnT, should be clarified in larger studies.
BackgroundRotator cuff tear (RCT) and hand osteroarthritis (HOA) are commonly accompanied because they share a similar pathogenesis. However, there was no previous study investigating the relationship between RCT and HOA.ObjectivesTo estimate the prevalence and associated factors of RCT in patients with HOA.MethodsIn this study, we enrolled 1150 farmers who lived in Gyeongnam province in Korea from June 2013 to December 2015. Physical examinations were performed by rheumatologists and orthopedists. Plain radiography of hands and magnetic resonance imaging (MRI) of shoulders were performed in all participants. Serum levels of high sensitive C-reactive protein (hsCRP) and high density lipoprotein (HDL) were checked. RCT was diagnosed by clinical examination and MRI findings. Diagnosis of HOA was made by the 1990 American College of Rheumatology classification criteria. Severity of HOA was defined as Kellgren–Lawrence (KL) grade ≥3 on plain radiographs. Erosive HOA was defined as having eroded 'E' or remodelled 'R' phase of the Verbruggen.ResultsThe prevalence of RCT was higher in patients with HOA group (192/307, 62.5%) than those without HOA (410/827, 49.5%, p<0.010). Among 307 with HOA, patients with RCT were older (62.69±7.04 vs. 59.11 ±7.69, p<0.001) and showed higher hs-CRP (1.51±3.78 vs. 0.67±0.70, p=0.004) and lower HDL levels (55.66±15.46 vs. 60.48±12.45, p=0.003) compared to those without RCT. There were no significant differences in gender, smoking, comorbidities, work period, body mass index, number of affected joints, HOA severity, and prevalence of erosive HOA between both groups. Multiple logistic regression analysis showed significant associations of age (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.02 - 1.10), serum levels of hsCRP (OR 1.37, CI 1.04 - 1.80), and HDL (OR 2.13, CI 1.14 - 3.98) with RCT in HOA patients.ConclusionsThe prevalence of RCT is high and age and serum levels of hsCRP and HDL have predictive roles in the development of RCT in HOA patients.ReferencesJin X, Beguerie JR, Zhang W, Blizzard L, Otahal P, Jones G, Ding C. Extended report: Circulating C reactive protein in osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2015;74(4):703–10.AcknowledgementThis study was supported by a grant of the Center for Farmer's Safety and Health, Ministry of Agriculture, Food and Rural Affairs, Republic of Korea.Disclosure of InterestNone declared
Chronic rheumatic valve disease (CRVD) is a late sequel of Rheumatic Fever (RF) which appears in approximately 30% of RF patients, leading to valve injury. Advanced Oxidation Protein Products (AOPP) and high sensitive C-Reactive Protein (hs-CRP) plasma levels were measured in patients with CRVD in order to evaluate the presence of oxidative stress and systemic inflammation. A total of 90 patients (70 female, 20 male, mean age 46.01 ± 11.72 years, range 24–69 years) with CRVD, who have or have not undergone valve replacement due to rheumatic ethiology, and 46 healthy subjects (27 female, 19 male, mean age 41.89 ± 9.02 years range 28–60 years) were studied. Levels of AOPP were measured by the determination of optical density (OD) at 340 nm under acidic conditions and hs-CRP by enhanced immunonephelometric assays. Significantly elevated levels of AOPP and hs-CRP were observed in CRVD patients when compared to the controls (AOPP 212.62 ± 34.14 umol/l vs. 126.97 ± 27.74 umol/l p < 0.00006 and for hs-CRP 5.40 ± 1.98 mg/l vs. 2.66 ± 1.36 mg/l p < 0.05). In addition, high levels of AOPP were associated to the presence of prosthethic valve and time after surgery ( p < 0.0008 and p < 0.005, respectively). No correlation was observed between the levels of AOPP and hs-CRP with age, sex and degree of mitral valve stenosis. No correlation was found between AOPP and hs-CRP plasma values. These results suggest the involvement of oxidative stress and systemic inflammation in the pathogenesis of CRVD.
Background: Viruses and bacteria like Chlamydia pneumoniae and Helicobacter pylori have been suggested to have a role in pathogenesis of overweight and obesity. Objective: We studied whether C. pneumoniae-specific IgG antibodies are associated with elevated body mass index (BMI), waist and hip circumference, and/or waist-hip ratio (WHR), and whether the risk is more pronounced in the simultaneous presence of an ongoing inflammation as measured by elevated high-sensitive C-reactive protein (hsCRP) levels. Subjects and methods: Our study population was derived from the Northern Finland Birth Cohort 1966 (NFBC1966), a general population sample of 12 058 live-born children. This cross-sectional study consisted of 5044 persons at 31 years of age. Serum C. pneumoniae IgG titers were measured by microimmunofluorescence test, and hsCRP levels by immunoenzymometric assay. Results: C. pneumoniae IgG positivity (titer >= 32), both alone and jointly with elevated hsCRP (>= 1.64mg l(-1), an upper quartile), was found to significantly associate with elevated BMI in the whole study population and with elevated hip and waist circumference in women, yet no association with WHR was seen. The analyses were adjusted for sex (when appropriate), smoking, socioeconomic position, glucose, insulin, high-and low-density lipoprotein cholesterols, triglycerides, leukocytes and pulse pressure. Conclusion: These findings suggest that especially in women, persistent C. pneumoniae infection may be associated with overweight/obesity, independently of more traditional risk factors. International Journal of Obesity (2011) 35, 1470-1478; doi:10.1038/ijo.2011.21; published online 8 March 2011
To analyze the relationship between serum ferritin(SF) level and high sensitive C reactive protein( hs-CRP) in men and the risk of gout. We chosed 600 male patients diagnosed with gout as gout group, 600 male patients with hyperuricemia were diagnosed as hyperuricemia group, and randomly selected 600 cases of the same period of male health examination as the control group. The detection information of physical examination and related indicators of three groups were collected, such as height, weight, serum ferritin, high sensitive C reactive protein, uric acid( UA), fasting blood glucose( FPG), triglyceride(TG), total cholesterol( TC) and so on. Serum ferritin( SF) higher than that of hyperuricemia group 114. 45 μg/L( P<0. 05)and the control group 76. 02 μg/L( P<0. 05), while the level of hs-CRP in gout patients up to 0. 3 mg/dL, was significantly higher than that 0. 13 mg/dL in hyperuricemia group and 0. 09 mg/dL in control group( all P<0. 05). After adjusting for BMI, TG, TC, FPG and UA five confounding fact
To investigate the relationship between serum uric acid (SUA) levels and high sensitive C-reactive protein (hs-CRP) in patients with type 2 diabetes mellitus (T2DM). A total of 400 patients who were hospitalized in the Department of Endocrinology and Metabolism of Jinshan Branch, Shanghai Sixth People's Hospital between April 2014 and December 2015 were divided into normouricemia (NUA, =319) group and hyperuricemia (HUA, =81) group according to the presence of HUA. Clinical features of the two groups were compared. Patients were further stratified into quartiles based on SUA levels, and then association between hs-CRP and SUA was analyzed. Compared to the NUA group, the patients with HUA had higher hs-CRP concentration [2.12 (1.15, 6.73) mg/L vs 1.14 (0.52, 3.44) mg/L, <0.001], erythrocyte sedimentation rate (ESR) [19.0 (10.5, 29.5) mm/h vs 12.0 (8.0, 17.0) mm/h, <0.001], body mass index (BMI) [(25.2±3.6) kg/m(2) vs (23.6±3.6) kg/m(2,) <0.001], and homeostasis model assessment-2 of insulin resistance (HOMA2-I
Summary Background: Traditional risk factors such as hyperlipidemia induce a state of inflammation that impairs vascular function. Despite marked maternal hyperlipidemia, endothelial function improves during pregnancy. In non‐pregnant state increased circulating levels of pro‐inflammatory cytokines and high sensitive C‐reactive protein (hsCRP) lead to attenuated flow mediated vasodilation. Relation between endothelial function and pro‐inflammatory cytokines has not been studied thoroughly in pregnancy. The aim of this study was to evaluate the effect of pregnancy on hsCRP and pro‐inflammatory cytokines and their associations with vascular endothelial function. Methods: As part of population‐based, prospective cohort Cardiovascular Risk in Young Finns study conducted in Finland we measured brachial artery flow mediated dilation (FMD) and serum concentrations of hsCRP, interleukin‐6 (IL‐6) and tumor necrosis factor‐α (TNF‐α) in 57 pregnant Finnish women throughout gestation and 62 control women matched for age and smoking. Results: HsCRP‐concentration was greater in pregnancy compared to non‐pregnant controls (median hsCRP 2·52 mg l−1 versus 1·21 mg l−1, P<0·001). IL‐6‐concentration was slightly increased in pregnancy compared with the non‐pregnant controls (median 1·66 versus 1·32 mg l−1, non‐significant [NS]) and TNF‐α‐concentration was slightly decreased in pregnant group (2·11 versus 2·38 pg ml−1, NS). FMD increased during pregnancy and IL‐6 had a positive correlation to the FMD in pregnancy (R = 0·288, P = 0·031). Conclusions: Improvement of FMD in normal pregnancy was not affected by increase in hsCRP concentration. We found an association with IL‐6 and FMD but we believe that improvement in endothelial function during normal pregnancy is not caused by variation in hsCRP, IL‐6 or TNF‐α.
To confirm the existence of obesity-induced inflammation and to clarify the association between such inflammation and other cardiovascular risk factors, we investigated the relationships between high-sensitive C-reactive protein (hsCRP), tumor necrosis factor α (TNF- α), obesity, blood pressure, lipids, and insulin resistance in a long-term follow-up of obese children. We compared the serum concentrations of hsCRP, TNF- α, high-density lipoprotein cholesterol, and triglycerides as well as blood pressure and the insulin resistance index (homeostasis model assessment [HOMA]) of 14 nonobese and 31 obese children. Furthermore, we studied the changes in these parameters in 16 obese children who lost weight and in 15 obese children without weight change over a 1-year period. In the obese children, blood pressure ( P = .003), HOMA ( P = .034), and triglyceride ( P = .011), TNF- α ( P = .015), and hsCRP ( P < .001) levels were significantly higher, whereas high-density lipoprotein cholesterol concentrations were significantly ( P = .015) lower compared with the nonobese children. Weight loss was associated with a significant decrease in hsCRP ( P = .008) and triglyceride ( P = .048) levels, HOMA ( P < .001), and blood pressure ( P = .019), whereas there were no significant changes in the children with stable weight status. The changes in hsCRP and TNF- α levels over the 1-year period were not significantly correlated to the changes in lipids, blood pressure, and HOMA. Obese children demonstrated significantly higher levels of hsCRP and TNF- α compared with nonobese children. The chronic inflammation markers TNF- α and hsCRP were independent of lipids, blood pressure, and insulin resistance index. Weight loss was associated with the significant decrease of hsCRP and triglyceride levels, and blood pressure.
. Objectives. Elevated C‐reactive protein (CRP) is a suggested risk marker for cardiovascular disease. We aimed at investigating the distribution and determinants of CRP levels in young adults. Design. Population‐based study. Subjects. A total of 2120 participants aged 24–39 years. Main outcome measures. Distribution of CRP, and the relationship between CRP and risk factors. Results. CRP concentration (mean ± SD) was 1.43 ± 3.26 mg L−1 in men, 1.36 ± 2.36 mg L−1 in women who did not use oral contraceptives (OC) and 3.69 ± 6.01 mg L−1 in women who used OCs. In total, 8.8% of men, 10.3% of non‐OC user women and 35.3% of OC user women had CRP concentration >3 mg L−1 (recommended cut‐off point of high risk for cardiovascular disease). In univariate analysis, CRP was associated with obesity indices and physical activity amongst both sexes. In men, the multivariate correlates of CRP included waist circumference (P < 0.0001), smoking (<0.0001) and HDL cholesterol (P = 0.024) (inverse association). These three variables explained 21.9% (model R2) of the total variation in CRP, waist circumference having the greatest influence (partial R2 = 19.6%). In women, the multivariate correlates of CRP included OC use (P < 0.0001), body mass index (BMI) (P < 0.0001), triglycerides (<0.0001) and physical activity (P = 0.025) (inverse association). These four variables explained 38.2% (model R2) of the total variation in CRP, with OC use (partial R2 = 18.4%) and BMI (partial R2 = 18.0%) having the greatest influence. Conclusions. The determinants of CRP level include obesity and smoking in men, and obesity, OC use and physical activity in women. About one in three of healthy women who use OCs have CRP concentration exceeding 3 mg L−1.
Background: In the current meta-analysis, we aim to assess the effect of high-sensitive C-reactive protein (hs-CRP) on in-stent restenosis (ISR) outcome in patients receiving stent implantation. Methods: Embase, PubMed, and Cochrane databases were searched through October 2016 using the keywords "high-sensitive C-reactive protein," "in-stent restenosis." An odds ratio (OR) of on ISR endpoints among patients receiving stent implantation was calculated using random-effects models. Results: In the meta-analysis of 6 prospective observational studies, there are 1156 coronary heart disease (CHD) patients, a total of 885 stents were implanted and 194 ISR events had been followed up for 6 to 12 months; high-sensitive C-reactive protein levels are associated with the prediction of in-stent restenosis among patients receiving stent implantation. The OR of hs-CRP for ISR was 1.16 [95% confidence interval (CI), 1.01-1.30, P < .05]. Conclusions: This meta-analysis shows that higher levels of hs-CRP are associated with an increased risk of ISR and indicate a poorer prognosis in CHD patients after stent implantation.