C-reactive protein and echocardiography have little impact on risk stratification in never-treated hypertensive patients

The aim of this study was to assess the contribution of increased concentrations of high-sensitivity C-reactive protein (hsCRP) and echocardiography to risk stratification according to the 2003 European guidelines for the management of arterial hypertension in patients with untreated hypertension. A total of 207 consecutive medical outpatients with untreated hypertension were included. History and clinical examination, electrocardiography, laboratory analyses including the measurement of hsCRP and echocardiography were performed in all patients. Patients were classified into four risk groups with and without using echocardiography and hsCRP concentrations of at least 10 mg/l according to the 2003 guidelines for the management of hypertension. The majority of the 207 patients (81%) were at moderate or high cardiovascular risk before adding echocardiography and/or hsCRP to the risk stratification process. When echocardiography was included, only three patients were reclassified from the moderate added risk to the high added risk group. Adding hsCRP concentrations of at least 10 mg/l had no impact on risk stratification. Using an hsCRP cutoff level of 3 mg/l, one patient was at moderate instead of low added risk, eight patients were at high instead of moderate added risk and one patient was at very high instead of high added risk. We conclude that hsCRP at the proposed cutoff level of 10 mg/l has no impact on risk stratification in outpatients with untreated hypertension. An hsCRP cutoff level of 3 mg/l may be more suitable for risk stratification. Finally, our data suggest that depending on the population studied, there is minimal impact of echocardiography on risk stratification.     

Relations of plasma high-sensitivity C-reactive protein to traditional cardiovascular risk factors

Variations of circulating C-reactive protein (CRP) levels are supposed to reflect chronic inflammatory process of the cardiovascular system. In particular, it has been reported that high-sensitivity CRP (hsCRP) is a promising marker of coronary heart disease. In the present study, we assessed the relationship between hsCRP and classic cardiovascular risk factors, such as age, blood pressure, smoking habit and serum lipids. Plasma hsCRP was measured by ELISA in 908 subjects, aged 30-79 years, who entered our health-check program. Plasma hsCRP level was 0.54+/-0.02 mg/l in 566 subjects without any disease currently treated. The level was significantly higher in patients treated for hypertension (0.74+/-0.06 mg/l, P=0.002), diabetes mellitus (0.77+/-0.09 mg/l, P=0.016) or coronary artery disease (0.99+/-0.16 mg/l, P=0.008) than in subjects without diseases. In a simple regression analyses of the 566 subjects without diseases, plasma hsCRP positively correlated with male gender, smoking, body mass index, systolic blood pressure, white blood cell count, blood hemoglobin, fasting blood glucose, serum gamma-GTP, uric acid and triglycerides, and inversely correlated with serum albumin and HDL-cholesterol. In multiple regression analysis, white blood cell count (r=0.276, P<0.001), body mass index (r=0.246, P<0.001), age (r=0.122, P=0.001) and smoking (r=0.112, P=0.009) showed independent correlations with plasma hsCRP. It is suggested that variation of circulating hsCRP, even within normal range, is involved in the interrelation of cardiovascular risk factors, such as age, smoking, obesity, high blood pressure and dyslipidemia, which are supposed to promote atherosclerosis and ultimately provoke cardiovascular diseases, such as coronary artery disease.     

心血管事件高危患者餐后高敏C反应蛋白浓度变化及氟伐他汀干预的影响

目的 研究心血管事件高危患者高脂餐后血浆高敏C-反应蛋白(hsCRP)浓度的变化,探讨极短期氟伐他汀对血浆hsCRP浓度的影响。方法 43例冠心病及其等危症患者随机分为氟伐他汀组(22例)和常规治疗组(21例),分别在常规治疗的基础上加服氟伐他汀(40 mg/d)和安慰剂。治疗前和1周后接受高脂餐负荷试验,检测空腹和餐后4 h血浆hsCRP和血脂水平。结果 两组患者的餐后血浆甘油三酯和hsCRP浓度较空腹水平明显升高(P<0.05)。1周后,常规治疗组的空腹和餐后血浆hsCRP浓度与血脂水平无显著变化;氟伐他汀组的餐后血浆甘油三酯和hsCRP浓度较治疗前显著降低,但血浆hsCRP浓度降低与血脂的变化无显著相关。结论 极短期氟伐他汀治疗有效降低心血管事件高危患者餐后升高的血浆hsCRP浓度。     

高敏C反应蛋白与高血压病患者合并颈动脉粥样硬化的关系

目的探讨炎症标记物高敏C反应蛋白(hs-CRP)与高血压病患者中颈动脉粥样硬化发生的关系。方法对入选的202例高血压病患者进行颈动脉超声检查测量颈总动脉内膜中层厚度(IMT)、观察有无斑块形成,并进行血清hs-CRP定量检测。根据患者颈动脉粥样硬化程度、是否合并糖尿病及吸烟情况分组进行血清hs-CRP水平比较。结果(1)合并颈动脉粥样硬化的高血压病患者血清hs-CRP显著高于无颈动脉粥样硬化患者[(4.96±5.26)mg/Lvs(3.16±3.54)mg/L,P=0.006]。(2)颈动脉斑块组患者平均血清hs-CRP显著高于颈动脉正常组患者[(5.35±4.82)mg/Lvs(3.16±3.54)mg/L,P=0.002]。(3)根据吸烟情况进行分层后,1年内有吸烟行为者中颈动脉斑块硬化组患者血清hs-CRP平均值明显高于颈动脉正常组[(5.30±5.02)mg/Lvs(3.07±1.70)mg/L,P=0.024]。(4)无糖尿病的高血压病患者中,颈动脉粥样硬化组患者血清hs-CRP均值高于颈动脉正常组[(5.03±5.35)mg/Lvs(3.25±3.61)mg/L,P=0.032]。结论合并颈动脉粥样硬化尤其有颈动脉斑块的高血压病患者血清hs-CRP显著高于无颈动脉粥样硬化患者。     

Intensive cardiovascular examination regarding blood pressure levels: evaluation of risk groups. ICEBERG study

Objective. Assessment of total cardiovascular risk level is crucial for approaching hypertensive patients. Therefore, the aim of the Intensive/Initial Cardiovascular Examination regarding Blood pressure levels: Evaluation of Risk Groups (ICEBERG) study is to determine cardiovascular risk evaluation and stratification of subjects with high normal and high blood pressure (BP≥130/85 mmHg), and to evaluate the impact of laboratory tests on this stratification. Methods. ICEBERG was an epidemiological study conducted at 20 university hospitals and 197 primary healthcare centers. A total of 10,313 patients, who were diagnosed with high BP and under antihypertensive treatment or not antihypertensive under treatment at least for the last 3 months were selected. Besides routine clinical evaluation, microalbuminuria (MAU) and high sensitive C-reactive protein (hs-CRP) tests, echocardiography (Echo) and carotid ultrasonography (USG) were performed in selected arms. The patients were stratified into low, moderate, high and very high added risk groups as described by the European Society of Hypertension/European Society of Cardiology Guidelines Committee (2003). Results. Upon routine evaluation, the percentage of “high and very high added cardiovascular risk” groups was between 51.2% and 60.7% in different study arms. This percentage increased to 62.9% by subsequent serum biochemistry assessment and to 76.2% by hs-CRP test results. Switching upwards to “high and very high added risk” groups was around 6% when MAU results were used, with a 4.9% upwards switch to “high and very high added risk” groups when Echo was performed; this proportion increased by 6.8%, when carotid USG was taken into account. Conclusion. Cardiovascular risk evaluation by intensive cardiovascular examination including Echo and carotid USG provided more accurate risk stratification. Furthermore, a simple test to demonstrate presence of MAU usable at primary healthcare level will also help to evaluate the patient's risk profile better than routine assessment methods alone.     

Fluvastatin blunts the effect of a high-fat meal on plasma triglyceride and high-sensitivity C-reactive protein concentrations in patients at high risk for cardiovascular events

BACKGROUND: The postprandial state is critical in atherogenesis. The aims of this study were to study the postprandial change of plasma high-sensitivity C-reactive protein (hsCRP) concentrations in patients at high risk for cardiovascular events, and to explore the influence of fluvastatin on hsCRP concentration. METHODS: Forty-three patients at high risk for cardiovascular events and 15 healthy controls participated in this study. All participants received an oral high-fat meal (800 calories; 50 g fat) at baseline. Blood samples were drawn at 0 and 4 h to measure the plasma concentrations of triglyceride, total cholesterol, low-density and high-density lipoprotein cholesterol and hsCRP. Then patients at high risk were randomly divided into two groups to accept fluvastatin (40 mg/day) (fluvastatin group, n=22) or placebo (placebo group, n=21). One week later, the high-fat meals were repeated and plasma samples were collected again. RESULTS: The postprandial plasma triglyceride concentrations increased in all participants, whereas the postprandial plasma hsCRP concentrations increased significantly only in patients at high risk (P<0.05), but not in healthy controls. After 1 week, the fasting or postprandial plasma lipid levels and hsCRP concentrations did not significantly change in the placebo group compared with the levels at baseline, whereas the postprandial plasma triglyceride and hsCRP concentrations significantly decreased in the fluvastatin group. The reduction of plasma hsCRP concentration was not related to the change of plasma triglyceride concentration. CONCLUSION: Fluvastatin effectively reduced postprandial plasma hsCRP concentrations in patients at high risk for cardiovascular events in a very short period of time.     

氯沙坦钾对原发性高血压患者高敏C反应蛋白及胰岛素抵抗的影响

目的探讨氯沙坦钾对原发性高血压患者高敏C反应蛋白(hs-CRP)及稳态模型评估的胰岛素抵抗指数(HOMA-IR)的影响。方法选择51例轻中度原发性高血压患者,经2周安慰剂洗脱后随机分为2组,治疗组给予氯沙坦钾,每日50mg,对照组给予硝苯地平缓释片10mg,每日2次。疗程为8周。在2周洗脱期末及8周末空腹抽静脉血,测定hs–CRP、血糖、胰岛素水平,用HOMA-IR公式计算胰岛素抵抗指数。比较治疗前后hs–CRP、空腹胰岛素、HOMA–IR变化。结果两组患者治疗8周后,收缩压、舒张压均有显著下降,差异有统计学意义(P<0.001);氯沙坦组治疗后血清hs-CRP、空腹胰岛素水平、HOMA-IR明显降低,与治疗前比较差异有统计学意义(P<0.05)。对照组治疗后hs-CRP、空腹胰岛素水平、HOMA-IR与治疗前比较差异无统计学意义(P>0.05)。氯沙坦组治疗前后hs-CRP、空腹胰岛素水平、HOMA-IR变化值与对照组比较差异有统计学意义(P<0.05,P<0.01,P<0.05)。两组治疗前后血糖水平差异无统计学意义。结论氯沙坦钾有效控制血压,降低hs-CRP水平,有改善胰岛素抵抗作用。     

高血压患者血清高敏C反应蛋白与血压分级的关系研究

目的探讨血清高敏C反应蛋白水平与中老年人高血压分级的关系。方法选取2013年6月至2013年11月于北京市安贞医院体检的209例中老年人为研究对象,根据中国高血压防治指南2010的诊断标准分为对照组(n=105)和高血压组(n=104),后者再根据高血压程度分为高血压病1、2、3级3个亚组,所有受试者均检测血清高敏C反应蛋白(hs-CRP)水平。结果对照组患者血浆hs-CRP水平为(1.57±2.18)mg/L,高血压组患者hs-CRP水平为(3.91±4.64)mg/L,两组比较差异具有统计学意义(P0.05)。与高血压病1级hs-CRP水平[(2.95±3.27)mg/L]比较,高血压病2级hs-CRP水平[(5.73±4.00)mg/L]增高,但差异无统计学意义(P0.05);而高血压病3级hs-CRP水平[(7.60±8.13)mg/L]明显升高,差异有统计学意义(P0.05)。高血压病3级较高血压病2级hs-CRP水平明显升高(P0.05)。结论高血压患者血清hs-CRP水平增高,高血压分级越高,血清hs-CRP水平增高越显著。     

C-reactive protein gene polymorphisms, C-reactive protein blood levels, and cardiovascular disease risk

C-reactive protein (CRP), a blood marker of inflammation and a hallmark of the acute-phase response, has been shown to be a powerful and specific predictor of cardiovascular event risk in populations of otherwise healthy persons. Here we review what is known about CRP gene polymorphisms, discuss how these might affect the epidemiology of CRP and our understanding of CRP's contribution to cardiovascular disease, and examine their potential clinical usefulness. Evidence shows that certain subtle variations in the CRP gene sequence, mostly single nucleotide polymorphisms, predictably and strongly influence the blood level of CRP. Some of these variations are associated with clinical correlates of cardiovascular disease. If future studies can establish with certainty that CRP influences cardiovascular biology, then CRP gene profiling could have clinical utility.     

Utility of C-reactive protein measurement in risk stratification during primary cardiovascular disease prevention

High-sensitivity C-reactive protein (hs-CRP) adds prognostic information beyond that provided by the Framingham risk score. The clinical utility of hs-CRP evaluation per guidelines was investigated by determining how it changed the cardiovascular risk stratification of 100 patients deemed at intermediate risk. Screening guidelines defined the cardiovascular risk due to hs-CRP as low (<1.0 mg/L), intermediate (1.0 to 3.0 mg/L), or high (>3.0 mg/L). After hs-CRP evaluation, risk was adjusted in 66% of the patients. Because hs-CRP evaluation significantly altered the cardiovascular risk strata of most intermediate-risk patients, it may therefore be a useful test during primary cardiovascular disease prevention.     

Risk stratification and prognostic implication of plasma biomarkers in nondiabetic patients with stable coronary artery disease: the role of high-sensitivity C-reactive protein

STUDY OBJECTIVES: To evaluate the implication of plasma biomarkers to future cardiovascular events in nondiabetic patients with stable coronary artery disease (CAD).Designs and settings: Prospective, follow-up study at a tertiary referral center.Patients and measurement: Serial plasma biomarkers including high-sensitivity C-reactive protein (hsCRP), homocysteine, soluble adhesion molecules, von Willebrand factor, and lipid profiles were determined before coronary angiograms in a series of nondiabetic CAD patients with stable angina. Among them, 75 consecutive patients who received coronary revascularization (48 coronary interventions and 27 coronary bypass surgeries) later and another 75 age- and gender-matched patients who preferred medical treatment were both enrolled. In patients of each group, major cardiovascular events including cardiac death, nonfatal myocardial infarction, new or repeated coronary revascularization, and hospitalization for unstable angina, stroke, or peripheral artery disease were prospectively followed up for at least 6 months. RESULTS: Patients were followed up to 40 months (median, 18 months). The incidences of major cardiovascular events were similar between the two groups. For patients with medical treatment, plasma levels of hsCRP, homocysteine, low-density lipoprotein, and the ratio of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL-C) were significantly higher in those with cardiovascular events than those without. However, only hsCRP > 0.1 mg/dL (relative risk [RR], 2.78; 95% confidence interval [CI], 1.21 to 6.41; p = 0.016) and TC/HDL-C ratio > 4.8 (RR, 2.42; 95% CI, 1.04 to 5.65; p = 0.041) were independent predictors by multivariable analysis. For patients with revascularization, basal plasma hsCRP levels were higher in those with cardiovascular events than those without (p = 0.04). However, no biochemical markers could predict future major cardiovascular events in these patients. CONCLUSIONS: In nondiabetic patients with CAD, basal plasma hsCRP levels were increased with future cardiovascular events regardless of different treatment strategies. Both plasma hsCRP level and TC/HDL-C ratio independently predict future cardiovascular events, confirming the role of plasma biomarkers in clinical risk stratification especially in patients with medical treatment.     

Evaluation of the metabolic syndrome in hypertensive patients: results from the ICEBERG Study

The Intensive/Initial Cardiovascular Examination Regarding Blood Pressure Levels: Evaluation of Risk Groups (ICEBERG) study was aimed at evaluating the components of the metabolic syndrome (MS) for cardiovascular risk stratification in hypertensive patients. The ICEBERG study consisted of 2 subprotocols: ICEBERG-1, conducted at 20 university hospitals, and ICEBERG-2, conducted at 197 primary health care centers. Each subprotocol had 2 patient profiles: patients diagnosed with hypertension and receiving medical treatment (treated group) and patients who had not received antihypertensive treatment (untreated group). MS was defined in the Third Report of the National Cholesterol Education Program Adult Treatment Panel as the presence of at least 3 of the following abnormalities: decreased plasma high-density lipoprotein cholesterol level, increased plasma triglyceride level, hypertension, increased fasting glucose level, and obesity. In a total of 4039 patients, 65.0% had MS, 30.2% had 3 components, 15.0% had 2 components, and 24.8% had 4 components. The most common accompanying component to hypertension was abdominal obesity. Therefore, this study underlined the value of questioning metabolic components in patients with high-normal or high blood pressure to identify individuals with high added risk of cardiovascular disease.     

Cardiovascular risk stratification in hypertensive patients: impact of echocardiography and carotid ultrasonography

BACKGROUND: Decision about the management of hypertensive patients should not be based on the level of blood pressure alone, but also on the presence of other risk factors, target organ damage (TOD) and cardiovascular and renal disease. OBJECTIVE: To evaluate the impact of echocardiography and carotid ultrasonography in a more precise stratification of absolute cardiovascular risk. METHODS: Never-treated essential hypertensives (n = 141; 73 men, 68 women, mean age 46 +/- 11 years) referred for the first time to our out-patient clinic were included in the study. They underwent the following procedures: (1) family and personal medical history, (2) clinical blood pressure (BP) measurement, (3) routine blood chemistry and urine analysis, (4) electrocardiogram, (5) echocardiogram, (6) carotid ultrasonogram. Risk was stratified according to the criteria suggested by the 1999 WHO/ISH guidelines. TOD was initially evaluated by routine procedures only, and subsequently reassessed by using data on cardiac and vascular structure obtained by ultrasound examinations (left ventricular hypertrophy (LVH) as left ventricular mass index (LVMI) > 134 g/m2 in men and > 110 g/m2 in women; carotid plaque as focal thickening > 1.3 mm). RESULTS: According to the first classification 20% were low-risk patients, 50% medium-risk, 22% high-risk and 8% very-high-risk patients. A marked change in risk stratification was obtained when TOD was assessed by adding ultrasound examinations: low-risk patients 18%, medium-risk 28%, high-risk 45%, very-high-risk patients 9%. CONCLUSIONS: The detection of TOD by ultrasound techniques allowed a much more accurate identification of high-risk patients, who represented a very large fraction (45%) of the patient population seen at our hypertension clinic. In particular, a large proportion of patients classified as at moderate risk by routine investigations were instead found to be at high risk when ultrasound examinations were added. The results of this study suggest that cardiovascular risk stratification only based on simple routine work-up can often underestimate overall risk, thus leading to a potentially inadequate therapeutic management especially of low-medium risk patients.     

C-reactive protein gene polymorphisms, C-reactive protein blood levels, and cardiovascular disease risk.

C-reactive protein (CRP), a blood marker of inflammation and a hallmark of the acute-phase response, has been shown to be a powerful and specific predictor of cardiovascular event risk in populations of otherwise healthy persons. Here we review what is known about CRP gene polymorphisms, discuss how these might affect the epidemiology of CRP and our understanding of CRP's contribution to cardiovascular disease, and examine their potential clinical usefulness. Evidence shows that certain subtle variations in the CRP gene sequence, mostly single nucleotide polymorphisms, predictably and strongly influence the blood level of CRP. Some of these variations are associated with clinical correlates of cardiovascular disease. If future studies can establish with certainty that CRP influences cardiovascular biology, then CRP gene profiling could have clinical utility.     

老年高血压患者心血管危险因素分层与认知功能障碍的相关性

目的探讨老年高血压患者心血管危险因素分层与认知功能障碍的关系。方法通过随机整群抽样的方法,选择西安地区老年高血压患者329例,根据心血管危险因素分层分为低危组62例,中危组77例,高危组108例,极高危组82例,又按简易智能状态检查量表(MMSE)评分分为认知功能正常组283例及认知功能障碍组46例。对不同分层及不同认知功能进行单因素及多因素分析。结果随着心血管危险程度的增加,低危组、中危组、高危组和极高危组的MMSE总分及各分项定向力、记忆力、回忆力、注意力、语言能力得分依次递减,差异有统计学意义;认知功能正常组与认知功能障碍组在年龄、职业、体育锻炼、做家务、参加社会活动、脑卒中及TG方面比较,差异有统计学意义(P<0.05,P<0.01);多因素回归分析显示,高龄、不参加体育锻炼、不做家务、不参加社会活动在2组间差异有统计学意义(P<0.05,P<0.01)。结论老年高血压患者随着心血管危险因素分层越高,认知功能障碍越重。高龄、不参加体育锻炼、不做家务、不参加社会活动是其认知功能障碍的重要危险因素。     

hs-CRP在支气管哮喘急性发作期的水平及其临床意义

［摘要］　目的　探讨支气管哮喘急性发作期患者血清超敏C-反应蛋白（hs-CRP）的水平及临床意义。方法　将收治的85例支气管哮喘急性加重期患者作为哮喘急性组,选择48例支气管哮喘缓解期患者作为哮喘缓解组,46名健康人作为对照组,分别测定三组研究对象血清hs-CRP以及肺功能指标。结果　三组研究对象间hs-CRP、FEV1%、FEV1/FVC%比较差异均有统计学意义（P<0.05）,其中急性组和缓解组hs-CRP水平均比对照组明显增高,而FEV1%、FEV1/FVC%则明显降低（P<0.05）;急性组hs-CRP水平比缓解组明显增高,而FEV1%、FEV1/FVC%明显降低（P<0.05）。随着哮喘严重程度的提高,hs-CRP水平也随之增高（P<0.05）。急性发作期患者血清hs-CRP水平与FEV1%、FEV1/FVC%均呈明显负相关（P<0.05）;而缓解期患者血清hs-CRP水平与FEV1%、FEV1/FVC%均无相关性（P>0.05）。结论　气管哮喘急性加重期患者血清hs-CRP水平明显增高,而且hs-CRP水平与患者肺功能密切相关。     

冠心病患者血清脂联素和高敏C反应蛋白的观察

目的探讨冠心病患者血清脂联素和高敏C反应蛋白(hs-CRP)水平的相关性。方法可疑冠心病患者83例行冠状动脉造影,确诊冠心病患者65例,分为稳定性心绞痛组(SAP组,21例)和急性冠状动脉综合征组(ACS组,44例),冠状动脉造影正常者作为对照组(18例)。测定各组患者血清脂联素和hs-CRP水平。结果ACS组患者血清脂联素对数水平较对照组和SAP组明显降低(P<0.05);ACS组患者hs-CRP水平高于SAP组和对照组(P<0.05)。线性相关分析表明,血清脂联素对数与hs-CRP水平呈负相关(r=-0.25,P<0.05)。结论血清脂联素与hs-CRP相互作用可能共同参与了冠状动脉粥样硬化的发生与发展。