High-sensitivity C-reactive protein at different stages of atherosclerosis: results of the INVADE study

Evidence on the role of high-sensitivity C-reactive protein (hsCRP) at different stages of atherosclerosis is limited. We therefore analyzed the relationship between hsCRP and measures of subclinical and advanced atherosclerosis in a population-based sample of the INVADE study (n = 3,092, >55 years). The parameters of interest were IMT, ABI, and the stage of atherosclerosis. Differences between participants with normal and pathological hsCRP were analyzed by t test for independent samples or Fishers’ exact test. Differences of hsCRP between IMT quartiles, ABI quartiles, and different stages of atherosclerosis were analyzed by one-way ANOVA. Adjusted stepwise multiple linear regression analysis (IMT and ABI) and adjusted analysis of variance (stage of atherosclerosis) were performed, including significant baseline parameters as covariates. ANOVA showed significant differences of hsCRP among IMT quartiles, ABI quartiles, and patients with and without atherosclerosis. The adjusted analyses confirmed that the effects of IMT, ABI, and atherosclerosis on hsCRP were independent from other significant baseline parameters, but did not yield a significant difference between subclinical and advanced stages of atherosclerosis. The present analysis indicates an independent relationship between hsCRP and both IMT and ABI as measures of subclinical atherosclerosis. The comparison of subclinical and advanced stages of atherosclerosis yielded no significant difference, indicating that hsCRP is sensitive to identify vascular risk patients, but not suited to monitor progression of the disease.     

Association of the -757T>C polymorphism in the CRP gene with circulating C-reactive protein levels and carotid atherosclerosis

Introduction

C-reactive protein (CRP) is an inflammatory protein that may play a role in the pathogenesis of atherosclerosis. CRP gene single nucleotide polymorphisms (SNPs) have been shown to be associated with CRP concentration; however, their independent effect on atherosclerosis has not been yet established. We aimed to determine whether the 5′-flanking -757T>C CRP gene polymorphism is associated with CRP concentration and carotid atherosclerosis.

Methods

We genotyped the -757T>C CRP gene SNP and determined the concentration of serum CRP, the intima-media thickness (IMT) of the common carotid artery and the existence of plaque/s in 612 apparently healthy men and women aged 66 ± 10 years.

Results

Carriers of the CRP -757C allele presented with higher IMT and higher CRP concentrations (p = 0.002, p = 0.042, respectively). After adjustment for vascular risk factors, linear regression analysis showed an independent effect of CRP -757C allele on carotid IMT, beyond serum CRP concentrations. This SNP was also associated with carotid plaque occurrence (O.R. 1.74, 95% CI 1.1-2.77, p = 0.002).

Conclusions

The present study provides evidence that a genetic variant of CRP gene is associated with carotid atherosclerosis, independently of traditional vascular risk factors. Further large-scale genomic studies are required, which may identify the genetic vulnerable subjects to develop atherosclerosis.     

Decreased plasma concentration of a novel anti-inflammatory protein--adiponectin--in hypertensive men with coronary artery disease

Aims: Recent studies indicate that adiponectin may have anti-inflammatory and anti-atherogenic properties, suggesting that hypoadiponectinemia can play a role in the pathogenesis of cardiovascular disease. Therefore the aim of the study was to assess plasma adiponectin concentration in hypertensive male patients with coronary artery disease (CAD). Associations of adiponectinemia with other cardiovascular risk factors were also analysed. Methods and results: The study included 99 consecutive male patients (median age 57 years) with hypertension and CAD who at the same time underwent coronary and renal angiography. The control group consisted of 62 BMI-matched healthy male blood donors (median age 48 years). Plasma adiponectin level was significantly lower in the CAD group as compared to the control group (4.01±0.18 vs. 4.88±0.24 μg/ml; p<0.01). There were no differences in plasma adiponectin concentration between hypertensive CAD patients with and without atherosclerotic renal artery stenosis. In the CAD group plasma adiponectin concentration correlated with levels of creatinine (r=0.56; p<0.001), HDL cholesterol (r=0.24; p<0.05), BMI (r=−0.33; p<0.001), glucose (r=−0.22; p<0.05) and triglycerides (r=−0.25; p<0.05). No correlation was found between plasma adiponectin and homocysteine concentrations. In a multivariate stepwise logistic regression model increasing concentrations of adiponectin were independently and significantly associated with a lower risk of CAD (OR 0.58 95% CI 0.42–0.81 p<0.001). Conclusions: Our results showed decreased plasma adiponectin concentration in the studied group of hypertensive men with CAD as compared to normotensive healthy subjects. This may suggest that decreased plasma adiponectin concentration is associated with a higher risk of CAD.     

A prospective evaluation of the directionality of the depression–inflammation relationship

Cross-sectional studies have found that individuals with depressive disorders or symptoms have elevated levels of inflammatory markers predictive of coronary artery disease, including interleukin-6 (IL-6) and C-reactive protein (CRP). Due to the paucity of prospective studies, however, the directionality of the depression–inflammation relationship is unclear. We evaluated the longitudinal associations between depressive symptoms and both IL-6 and CRP among 263 healthy, older men and women enrolled in the Pittsburgh Healthy Heart Project, a 6-year prospective cohort study. During the baseline and follow-up visits, participants completed the Beck Depression Inventory-II (BDI-II) to assess depressive symptoms and underwent blood draws to quantify serum IL-6 and CRP. Path analyses revealed that baseline BDI-II (β = 0.18, p = 0.01, ΔR² = 0.02) was a predictor of 6-year change in IL-6, even after adjustment for demographic, biomedical, and behavioral factors as well as other negative emotions. Of all the factors examined, only body-mass index was a stronger predictor of IL-6 change than depressive symptoms. In contrast to these results, baseline IL-6 did not predict 6-year change in BDI-II. Evidence of a weak bidirectional relationship between BDI-II and CRP was also observed; however, neither of these longitudinal associations was significant. The present findings indicate that depressive symptoms may precede and augment some inflammatory processes relevant to coronary artery disease among healthy, older adults. Therefore, our results imply that depression may lead to inflammation and that inflammation may be one of the mechanisms through which depression contributes to cardiovascular risk.     

Association of plasma retinol-binding protein-4, adiponectin, and high molecular weight adiponectin with metabolic adversities in patients with schizophrenia

Objective

Metabolic adversities are prevalent in patients with schizophrenia. Retinol-binding protein 4 (RBP4) and high molecular weight (HMW) adiponectin have been recently found to be associated with metabolic features in non-psychiatric population. The study aimed to evaluate the associations between metabolic features and RBP4, total adiponectin, and HMW adiponectin in patients with schizophrenia.

Methods

We recruited 109 patients with schizophrenia treated with clozapine or haloperidol and evaluated their body mass index (BMI), waist circumference, blood pressure, and fasting triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fasting plasma glucose, insulin, RBP4, total adiponectin, and HMW adiponectin levels.

Results

We found that patients with metabolic syndrome (MS) had higher RBP4 level, and lower total adiponectin and HMW adiponectin levels than those without MS. There were no significant differences in metabolic features and adipocytokine levels between patients treated with clozapine and haloperidol. Most of the metabolic indexes were significantly correlated with the levels of adipocytokines. After adjusting the effects of age, gender, and BMI, marginal significant correlations existed between TG and RBP4 levels; HDL-C and total adiponectin and HMW adiponectin; insulin and HOMA-IR and HMW adiponectin. Receiver operating curve analysis showed that all of the three adipocytokines could differentiate patients with MS from those without MS. Meanwhile, total adiponectin and HMW adiponectin, but not RBP4, had the differentiating power for insulin resistance.

Conclusion

Higher RBP4 and lower total adiponectin and HMW adiponectin levels were observed in schizophrenic patients with MS. Only HMW adiponectin is marginally correlated with insulin sensitivity. The finding that metabolic profiles, but not the antipsychotic types, are associated with adipocytokine levels should be confirmed in longitudinal studies.     

Association of posttraumatic stress disorder with low-grade elevation of C-reactive protein: Evidence from the general population

Background

Posttraumatic stress disorder (PTSD) has been associated with several somatic diseases, and low-grade inflammation may be one psychobiological mechanism mediating this relationship. We assessed the association between PTSD and elevated serum levels of C-reactive protein (CRP; >3 mg/L) in a large general population sample.

Methods

About 3049 adults living in the community were included in the present study. CRP, lipoproteins and triglycerides were determined. Participants were also examined with regard to blood pressure, body mass index (BMI), physical activity, comorbid somatic diseases, medication, daily alcohol intake, and depression.

Results

PTSD was diagnosed in 55 participants (1.8%), and low-grade inflammation (i.e. CRP >3 mg/L) was found in 701 subjects (23.0%). PTSD positive participants had significantly higher odds for elevated CRP values than those without PTSD (OR = 2.27; 95% CI: 1.32-3.93). Even after adjusting for sex, age, other sociodemographic factors, BMI, blood pressure, lipoproteins and triglycerides, physical activity, comorbid somatic diseases, daily alcohol intake, and trauma exposure, there were almost twofold higher odds for elevated CRP levels in participants with PTSD compared to those without PTSD (OR = 1.87; 95% CI: 1.05-3.35).

Conclusions

Our findings suggest a close relationship between PTSD and low-grade inflammation possibly representing one psychobiological pathway from PTSD to poor physical health, particularly with respect to cardiovascular and pulmonary disease as well as diabetes.     

长期糖皮质激素治疗对特发性炎性肌病Lp(a)和hs-CRP水平的影响

目的通过检测特发性炎性肌病(IIM)患者糖皮质激素(简称"激素")治疗前、后不同时期血清脂蛋白(a)〔Lp(a)〕、超敏C反应蛋白(hs-CRP)水平变化,观察激素对IIM患者体内炎性状态的影响。方法选择确诊IIM患者25例(肌炎组),分别在泼尼松片治疗前及治疗后第3、6、9、12个月采用免疫散色比浊法和免疫透射比浊法检测其血清Lp(a)和hs-CRP水平,同时检测血总胆固醇(CHO)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL-C)、尿酸、同型半胱氨酸(HCY)水平。另选择15名作者医院门诊体检的健康人员检测其上述指标,作为健康对照,进行比较分析。结果肌炎组治疗前Lp(a)、hs-CRP、CHO、LDL-C、HDL、血尿酸、HCY水平与对照组比较差异均无统计学意义(均P0.05)。肌炎组患者治疗后第3、6、9、12个月Lp(a)、hs-CRP水平均较治疗前及对照组明显升高(均P0.05),治疗后第6个月与第9、12个月比较无明显差异(P0.05)。肌炎组治疗后各观察月CHO、LDL-C、HDL、血尿酸、HCY水平及治疗后第3个月TG水平与治疗前及对照组比较差异无统计学意义(均P0.05);TG在治疗后第6、9、12月水平较对照组、治疗前及治疗后第3月时高(P0.05)。结论长期激素治疗的IIM患者可出现血清Lp(a)、hs-CRP水平升高。     

短暂性脑缺血发作、单/多发腔隙性脑梗死患者血纤维蛋白原水平与颈动脉及下肢动脉粥样硬化的相关性研究

目的探讨短暂性脑缺血发作（transient ischemic attack,TIA）、单/多发腔隙性脑梗死患者颈动脉及下肢动脉粥样硬化情况,明确血纤维蛋白原水平对颈动脉及下肢动脉粥样硬化的影响。方法对178例短暂性脑缺血发作、单/多发腔隙性脑梗死患者进行颈动脉及下肢动脉彩色多普勒超声检查,记录颈动脉及下肢动脉粥样硬化斑块的部位、大小、数目、回声、动脉分叉处内膜中层厚度（inti ma-media thickness,I MT）及血管内径,并测量血压及纤维蛋白原测定。结果颈动脉粥样硬化斑块位于颈总动脉分叉处最多（占58.3%）。I MT≥1.2mm组血纤维蛋白原水平显著高于I MT〈1.2mm组（P〈0.05）。下肢动脉粥样硬化位于股动脉最多（占49.6%）,I MT≥1.2mm组血纤维蛋白原水平显著高于I MT〈1.2mm组（P〈0.05）。高水平纤维蛋白原组（≥3.0g/L）易损斑块数量明显增多（P≤0.05）。颈动脉I MT与患者收缩压、舒张压以及纤维蛋白原水平呈正相关（r=4.89、5.37、6.47,P均〈0.05）,下肢动脉I MT与血糖及纤维蛋白原水平呈正相关（r=4.83、5.38、6.68,P均〈0.05）。结论血纤维蛋白原水平与短暂性脑缺血发作、单/多发腔隙性脑梗死患者颈动脉及下肢动脉粥样硬化程度呈正相关。     

糖尿病合并脑梗死患者血清C反应蛋白水平的改变及与颈动脉斑块形成和高血压病的关系

目的探讨糖尿病合并脑梗死患者血清C反应蛋白(CRP)水平的改变及与颈动脉斑块形成和高血压病的关系。方法采用散射比色法检测103例糖尿病、240例急性脑梗死和130例糖尿病合并急性脑梗死患者的血清CRP水平;用彩色超声多普勒诊断仪检测颈动脉斑块;调查患者的高血压病史。结果糖尿病脑梗死组和急性脑梗死组的血清CRP水平、双侧颈动脉斑块形成和高血压病的比率及病程明显高于或长于糖尿病组(P<0.01～0.001);糖尿病脑梗死组高血压病程显著短于急性脑梗死组(P<0.05)。结论糖尿病合并急性脑梗死患者的血清CRP水平比糖尿病患者明显升高。双侧颈动脉斑块形成和高血压病(尤其病程长)是糖尿病并发ACI的主要因素。     

Correlations among inflammatory markers in plasma, saliva and oral mucosal transudate in post-menopausal women with past intimate partner violence

The relationship between psychosocial factors and an increased risk for disease has been related to a heightened pro-inflammatory status reflected in increased circulating levels of pro-inflammatory cytokines and/or C-reactive protein (CRP). Routinely, epidemiological studies rely on measurements of inflammatory markers in serum or plasma, but the use of biological fluids such as saliva or oral mucosal transudate (OMT) may offer potential advantages. This study investigated correlations among plasma CRP and levels of IL-6 and soluble IL-6 receptor (sIL-6R) in plasma, saliva and OMT in a population of middle aged women with histories of past intimate partner violence (IPV). A total of 67 women without existing chronic diseases participated in the study, which included two visits each in which psychological tests were administered, and blood, saliva and OMT samples were collected. Although significantly higher plasma CRP levels were found in past IPV sufferers compared to controls, there were no significant differences in IL-6 or sIL-6R levels in plasma, saliva or OMT between the two groups. There were only relatively modest correlations between IL-6 levels in plasma and those in saliva or OMT and between plasma IL-6 and CRP levels. A significant correlation between IL-6 and sIL-6R levels in both saliva and OMT, but not in plasma, was also detected. No significant correlations were found between levels of IL-6 in saliva or OMT and periodontal health measures. Results indicate that IL-6 and sIL-6R levels in saliva or OMT do not closely reflect those in plasma, and therefore are not a good surrogate for systemic levels.     

The role of low-density receptor-related protein 1 (LRP1) as a competitive substrate of the amyloid precursor protein (APP) for BACE1

Cleavage of APP by BACE1 is the first proteolytic step in the production of amyloid-beta (Aβ), which accumulates in senile plaques in Alzheimer's disease. Through its interaction with APP, the low-density receptor-related protein 1 (LRP1) enhances APP internalization. Recently, BACE1 has been shown to interact with and cleave the light chain (lc) of LRP1. Since LRP1 is known to compete with APP for cleavage by gamma-secretase, we tested the hypothesis that LRP1 also acts as a competitive substrate for β-secretase. We found that the increase in secreted APP (sAPP) mediated by over-expression of BACE1 in APP-transfected cells could be decreased by simultaneous LRP1 over-expression. Analysis by multi-spot ELISA revealed that this is due to a decrease in sAPPβ, but not sAPPα. Interaction between APP and BACE1, as measured by immunoprecipitation and fluorescence lifetime assays, was impaired by LRP1 over-expression. We also demonstrate that APP over-expression leads to decreased LRP1 association with and cleavage by BACE1. In conclusion, our data suggest that - in addition to its role in APP trafficking - LRP1 affects APP processing by competing for cleavage by BACE1.     

急性脑梗死患者血浆纤维蛋白原和C反应蛋白水平的改变及其与病情和预后的关系

目的 探讨急性脑梗死(ACI)患者血浆纤维蛋白原(Fib)和C反应蛋白(CRP)水平的改变及其与病情和预后的关系.方法 检测86例脑梗死患者(CI组)、27例腔隙性脑梗死患者(LCI组)和48名健康人(正常对照组)的血浆Fib及CRP含量.在CI患者入院当天和4周时进行临床神经功能缺损程度评分(NDS)评定.结果 CI组和LCI组血浆Fib、CRP水平和异常率明显高于正常对照组(均P＜0.01);NDS重型患者血浆Fib、CRP含量明显高于中型、轻型患者(均P＜0.01);中型患者血浆CRP含量显著高于轻型患者(P＜0.01).血浆Fib和CRP含量异常组患者住院4周时显著进步和进步的比率明显低于正常对照组(均P＜0.01),而无变化和死亡的比率明显高于正常对照组(均P＜0.01).结论 ACI患者血浆Fjb和CRP水平均明显升高,病情重的患者升高更明显;血浆Fib、CRP含量升高的患者预后较差.     

血清五聚素3、超敏C反应蛋白、脂蛋白相关磷脂酶A2水平以及微栓子信号与大动脉粥样硬化型急性脑梗死患者颈动脉粥样硬化斑块稳定性的相关研究

目的探讨血清五聚素3(PTX3)、超敏C反应蛋白(hs-CRP)、脂蛋白相关磷脂酶A2(LpPLA2)水平以及微栓子信号(MES)与大动脉粥样硬化型急性脑梗死患者颈动脉粥样硬化斑块稳定性的关系。方法依据中国缺血性卒中亚型分型(CISS),选取起病72 h内大动脉粥样硬化型急性脑梗死患者78例,使用二维彩色多普勒超声检测仪对颈动脉斑块的解剖和病理类型进行分析,将患者分为不稳定斑块组(40例)和稳定斑块组(38例),并同期从体检中心选取健康成人30名作为对照组。测定所有观察对象血清PTX3、hsCRP以及Lp-PLA2水平,分析各组间三种血液学指标水平的差异,并分别对三种血液学指标水平与颈动脉斑块稳定性进行相关性分析。对不稳定斑块组和稳定斑块组患者行TCD监测,分析两组之间MES检出率的差异。结果不稳定斑块组及稳定斑块组血清Hcy、hs-CRP、PTX3、Lp-PLA2水平及高血压的比例均明显高于对照组(均P0.05);不稳定斑块组他汀类用药史的比例明显高于对照组,血清PTX3、Lp-PLA2水平明显高于稳定斑块组(均P0.05)。不稳定斑块组的MES检出率显著高于稳定斑块组(P0.05)。Logistic回归分析显示,血清PTX3、Lp-PLA2水平是与斑块稳定性密切相关的影响因素(均P0.05)。血清PTX3水平预测斑块稳定性的ROC曲线下面积为0.963(P0.05),其临界值为2.57 ng/m L时,灵敏度为78.9%,特异度为84.2%。血清Lp-PLA2水平预测斑块稳定性的ROC曲线下面积为0.927(P0.05),其临界值为54.35μg/L时,灵敏度为72.9%,特异度为81.6%。结论血清PTX3、Lp-PLA2水平可能是预测颈动脉斑块稳定性的生物学指标。MES监测对于颈动脉斑块的稳定性评估具有一定的临床意义。     

Association of levels of lipoprotein (a) and other lipoproteins with cerebrovascular disease in the Turkish population

Lipoprotein (a) [Lp (a)] is a cholesterol-rich lipoprotein that structurally resembles the low density lipoprotein cholesterol (LDL-C) particles, but contains a molecule of apolipoprotein (a) attached to apolipoprotein B by disulfide bond. Because of the fact that high plasma levels of Lp (a) have been shown to be associated with cerebrovascular disease (CVD), we determined plasma Lp (a) levels in CVD for the Turkish population, and compared them with previous findings of some developed countries. Plasma Lp (a) levels were evaluated in CVD and control groups. The mean plasma Lp (a) levels in the CVD group was found to be approximately two-fold higher than that of the control group (0.21 g/1 vs 0.38 g/1). Also, it was found to be higher than the mean levels of CVD group in the other populations described in previous reports. But CVD prevalence in the Turkish population is lower than in those of developed countries, especially United States and Japan. Therefore, we believe that each of those populations should determine their plasma Lp (a) levels to observe the risk for CVD.     

The role of the low-density lipoprotein receptor-related protein (LRP1) in Alzheimer's A beta generation: development of a cell-based model system

The clearance and degradation of extracellular Aβ is critical for regulating β-amyloid deposition, a major hallmark of brains of patients with Aβ in Alzheimer’s Disease. The low-density lipoprotein receptor-related protein, LRP1, is a large endocytic receptor that significantly contributes to the balance between degradation and production of Aβ. An extracellular portion of the LRP, known as the cluster II region can bind to the secreted form of APP (sAPP-KPI). We show here that a GST fusion protein containing the cluster II region of LRP can be used as a ‘mini-receptor’ that specifically binds to sAPP-KPI from conditioned cultured medium. The binding between the GST-LRP-cluster II fusion protein and sAPP-KPI can be inhibited with the strong binding ligand of LRP1, called receptor-associated protein (RAP). Furthermore, a cell-based in vitro assay system has been developed to monitor the production of total Aβ and Aβ_1–42 in the presence and absence of RAP in Chinese hamster ovary (CHO) cell lines both deficient in LRP and expressing LRP. A 3-day treatment of the L2 (CHO cells deficient in LRP and overexpressing APP751) and L3 (CHO cells expressing LRP and overexpressing APP751) cell lines with RAP showed a decrease in total Aβ and, interestingly, also a decrease in the ratio of Aβ₄₂/Aβ_total. This cell-based model system and LRP-cluster II mini-receptor will be very useful for screening novel compounds that can reduce Aβ accumulation by inhibiting binding of APP-KPI to LRP1.     

幽门螺杆菌感染与脑梗死患者颈动脉斑块稳定性、纤维蛋白原、C-反应蛋白的关系

目的 探讨脑梗死患者幽门螺杆菌(helicobacter pylori,Hp)感染与颈动脉斑块稳定性、纤维蛋白原、C-反应蛋白的关系.方法 选取在马鞍山中心医院住院的脑梗死患者185例,用14C-尿素呼气试验检测患者Hp的感染情况;根据颈动脉彩色超声多普勒检查结果,将患者分为无斑块组(81例)、不稳定斑块组(74例)、稳定斑块组(30例),测定血清C-反应蛋白、纤维蛋白原及Hp感染情况,并进行Logistic回归分析.结果 (1)不稳定斑块组患者血清C-反应蛋白水平和Hp感染显著高于稳定斑块组[(13.59±3.79)mg/L vs.(8.55±3.65) mg/L;86.5％ vs.63.3％,P＜o.05];(2)脑梗死患者C-反应蛋白、血清纤维蛋白原与颈动脉斑块稳定性呈负相关(OR值分别为0.425,0.174,P＜0.05),与稳定斑块组比较,不稳定斑块组Hp感染率更高.(3)多因素Logistic 回归分析显示高血压、C-反应蛋白、纤维蛋白原与颈动脉粥样硬化斑块的稳定性相关,Hp感染为脑梗死的重要危险因素(OR=0.706,95％ CI:0.368～0.951,P=0.019),性别在某种程度上可能是斑块稳定性的影响因素.结论 Hp感染与颈动脉易损斑块密切相关,测定Hp感染及C-反应蛋白对预测脑梗死的发病有重要意义.     

Dejerine-Sottas disease with a novel de novo dominant mutation, Ser 149 Arg, of the peripheral myelin protein 22

The Ser149Arg mutation of peripheral myelin protein 22 (PMP22) was found in a 19-year-old woman with a sporadic case of Dejerine-Sottas disease. The patient showed delayed motor development. She walked for the first time with support at the age of 2 years. Scoliosis developed at age 4 years. Her walking ability was best at age 11. Thereafter, she showed progressive muscle weakness and sensory disturbances in the distal extremities. At the age of 18 years, the use of a wheelchair became necessary. Motor and sensory nerve conduction studies showed absent motor and sensory responses on electrical stimulation of the limb nerves. A sural nerve biopsy specimen showed marked decreases in the numbers of both large and small myelinated fibers, abundant onion-bulb formation, and hypomyelination. Electron microscopic observation revealed the presence of demyelinated axons and myelin sheaths disproportionately thin relative to axon diameter. That this was a de novo mutation was established by parentage testing and PMP22 gene analysis of the parents. The mutation seems to be novel and dominant. Received: 12 April 1999 / Accepted: 14 June 1999     

Association between inflammation, lipid and hemostatic factors in patients with stable angina

INTRODUCTION: Dyslipidemia and thrombotic processes are both clearly involved in atherogenesis and its secondary complications. Moreover, inflammation has also been shown to play an important role in the pathophysiology of atherosclerosis. Our objective was to determine the association between inflammation, lipids and thrombosis in a group of patients with stable angina. PATIENTS AND METHODS: 295 patients (217 males and 78 females) with a mean age of 65.69+/-11.24 years. Levels of C-reactive protein, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, lipoprotein(a), apolipoproteins A1 and B100, fibrinogen and D-dimer were determined for each. RESULTS: Arithmetic and geometric means of C-reactive protein in the sample were 10.7 and 1.4 mg/l, respectively. Distributing the sample by quartiles of C-reactive protein, we found a positive correlation between C-reactive protein, fibrinogen and D-dimer levels (p<0.000), and an inverse correlation for HDL cholesterol and apolipoprotein A1 (p<0.000). In multivariate analysis, fibrinogen (p<0.000) and D-dimer (p<0.01) levels were independently associated with high levels of C-reactive protein. Of the lipid factors, only apolipoprotein A1 (p<0.000) was independently and inversely associated with high levels of C-reactive protein. CONCLUSIONS: These data confirm the association between prothrombotic and inflammatory states and suggest the anti-inflammatory effect of apolipoprotein A1.