Plasma concentrations of C-reactive protein and total homocysteine in relation to the severity and risk factors for cerebrovascular disease

Higher C-reactive protein (CRP) and plasma homocysteine (tHcy) concentrations have been shown to indicate increased risk of coronary heart disease and cerebrovascular disease (CVD), but the mechanisms by which they increase the risk of atherothrombotic disease are under investigation. This study evaluates the associations of high-sensitivity C-reactive protein (hs-CRP) and tHcy with the risk factors, severity, and outcome on discharge in patients with CVD. hs-CRP, fasting tHcy, and lipid profile were determined in 50 patients with CVD and 20 healthy control subjects. Clinical data, National Institutes of Health stroke scale (NIHSS) on admission and disability Rankin scale on discharge, were recorded. Based on epidemiologic studies, cutoff points of 1.5 mg/L (hs-CRP) and 15mumol/L (tHcy) were used to indicate increased risk. Univariate and multivariate logistic regression analyses were used to relate tHcy with other CVD risk factors, NIHSS on admission and the disability Rankin scale on discharge. Overall, 38% of patients had increased hs-CRP and 26% had elevated tHcy. hs-CRP (P = 0.005) and tHcy (P < 0.0001) concentrations were significantly higher in patients compared with controls, and these differences remained significant after correction for age and sex. tHcy showed significant correlations with hs-CRP (rs = 0.35; P = 0.003) and low-density lipoprotein-cholesterol (LDL-C; rs = 0.49; P = 0.005). Logistic regression analysis with CVD as the dependent variable showed significant association with hs-CRP (P = 0.01) and tHcy (P < 0.0001) after adjustment for potential confounders. hs-CRP showed increased trend with disease severity and significant association with the disability Rankin scale (P = 0.033). These data support 4 main conclusions: (1) Elevation of hs-CRP and tHcy are common in CVD; (2) the significant relationship between tHcy and hs-CRP suggests that the association of tHcy with CVD risk may be dependent on inflammation-related mechanisms; (3) increased hs-CRP and tHcy show that patients with CVD may be at greater risk of subsequent coronary heart disease; and (4) admission hs-CRP could be used as an indicator of prognosis.