C-Reactive Protein, a Sensitive Marker of Inflammation, Predicts Future Risk of Coronary Heart Disease in Initially Healthy Middle-Aged Men

Köenig, Wolfgang; Sund, M.; Fröhlich, Margit; Fischer, H. G.; Löwel, Hannelore; Döring, Angela; Hutchinson, Winston L.; Pepys, Mark B.

doi:10.1161/01.cir.99.2.237

Cited by 1,739 publications

(888 citation statements)

References 43 publications

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“…We found similar associations for abdominally obese participants with elevated CRP levels showing an increased risk for CHD compared with abdominally obese participants with low CRP levels. Previous studies linking CRP levels to CHD were performed largely in populations with a lower prevalence of obesity than that of the current US population 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32. In the 2 largest published studies of CRP and CHD disease,25, 27 the mean body mass index (in kg/m 2 ) of participants ranged from 25 to 26, lower than the recently reported mean of 28.7 in US adults,33 indicating the clinical need for data regarding CRP in obese populations.…”

Section: Discussionmentioning

confidence: 99%

C‐Reactive Protein Identifies Low‐Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer–Norfolk Prospective Population Study

Wijk

Boekholdt

Arsenault

et al. 2016

JAHA

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BackgroundConflicting data exist about the cardiovascular risk of metabolically healthy obese persons. The prognostic value of C‐reactive protein (CRP) in this intriguing group is unknown. We assessed the association between CRP levels and the risk of coronary heart disease (CHD) in metabolically healthy persons with abdominal obesity.Methods and ResultsIn the European Prospective Investigation of Cancer–Norfolk prospective cohort, CRP levels and information on metabolic syndrome criteria were available for 7279 participants, of whom 825 (11%) developed CHD during a follow‐up period of 10.9±1.8 years. There was a trend toward a higher multivariable‐adjusted hazard ratio for CHD in metabolically healthy obese participants with CRP levels >2 mg/L compared with <2 mg/L (hazard ratio 1.59, 95% CI 0.97–2.62, P=0.066). Metabolically unhealthy obese participants had significantly higher CHD risk compared with metabolically healthy obese participants with CRP levels <2 mg/L (hazard ratio 1.88, 95% CI 1.20–2.94, P=0.006). Most important, we found that the risk of CHD among metabolically healthy obese persons with CRP levels <2 mg/L was comparable to that of metabolically healthy nonobese persons (hazard ratio 0.91, 95% CI 0.60–1.39, P=0.674).ConclusionsAmong metabolically healthy obese persons, low CRP levels were associated with a CHD risk comparable to that of metabolically healthy nonobese persons. CRP appears to be an easy and widely available method for identifying a low‐risk subpopulation among metabolically healthy obese persons.

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Section: Discussionmentioning

confidence: 99%

C‐Reactive Protein Identifies Low‐Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer–Norfolk Prospective Population Study

Wijk

Boekholdt

Arsenault

et al. 2016

JAHA

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“…For people without diabetes, total dietary fiber intake is recommended to be 14 g/1000 kcal each day, including soluble and insoluble fibers [34]; the recommended intake is higher for individuals with diabetes [11,32]. Dietary fiber intake is inversely associated with levels of C-reactive protein [35], a marker of inflammation predicting future coronary heart disease (CHD) [36][37][38][39][40]. Soluble fiber is also of benefit in lowering low-density lipoprotein cholesterol and is mainly found in whole grains such as barley and oats and in legumes, fruits, vegetables, nuts, and ground flax seeds.…”

Section: Discussionmentioning

confidence: 99%

Low-carbohydrate and high-fat intake among adult patients with poorly controlled type 2 diabetes mellitus

Olendzki

Hafner

et al. 2006

Nutrition

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Objective-This study examined baseline dietary intake, body weight, and physiologic status in patients enrolled in a dietary intervention for type 2 diabetes mellitus (T2DM).Methods-Dietary, physiologic, and demographic information were collected at baseline from 40 adult patients with poorly controlled T2DM (glycosylated hemoglobin >7%) who participated in a clinical trial at an academic medical center in Worcester, Massachusetts, USA.Results-The average age at enrollment was 53.5 y (SD 8.4), average body mass index was 35.48 kg/m 2 (SD 7.0), and glycosylated hemoglobin was 8.3% (SD 1.2). Participants were predominantly white, married, and employed full time. Forty-eight percent were men. Seventy-eight percent had hyperlipidemia, and 68% had hypertension. Reported baseline daily average energy intake was 1778 kcal (SD 814), daily carbohydrate was 159 g (SD 71.5), and dietary fiber was 11.4 g (SD 5.2). The dietary composition was 35% carbohydrate, 45% fat (15% saturated fat), and 20% protein. The American Diabetes Association (ADA) guidelines recommends 45-65% of energy from carbohydrate, 20-35% from fat (<7% saturated), and 20% from protein.Conclusion-These patients reported a low-carbohydrate, low-fiber, high-fat (especially saturated) diet, although they stated they are not following any of the popular low-carbohydrate diets. Patients with T2DM may find the current trend toward reducing weight through low-carbohydrate diets attractive for control of blood glucose, despite ADA recommendations. This dietary pattern may represent a popular trend that extends beyond our particular study and, if so, has serious cardiovascular implications in this vulnerable population of T2DM patients.

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“…We also performed binomial multiple logistic regression analysis for the assessment of multiple predictors of CAD development. For this analysis, we used dichotomized age ≥55 years for men and ≥65 years for women (risk factor for CAD24) and hs‐CRP level ≥2 mg/L (marker of active inflammation25, 26) and all other binominal factors as predictors. Statistical analysis was performed using Statistica 10.0 (Statsoft, Dell, OK, USA) and SPSS Statistics 21.0 (IBM Corp, NY, USA).…”

Section: Methodsmentioning

confidence: 99%

Cytomegalovirus‐Productive Infection Is Associated With Acute Coronary Syndrome

Nikitskaya

Lebedeva

Ivanova

et al. 2016

JAHA

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BackgroundAlthough an association between human herpesvirus (HHV) infection and atherosclerosis has been suggested, the data supporting such an association are controversial and, in most cases, are based on serological evidence or on the presence of cell‐associated HHV DNA, which do not report about actual viral replication. We quantified the DNA of all 8 types of HHVs in plasma, in which their presence is evidence of viral replication.Methods and ResultsUsing quantitative real‐time polymerase chain reaction, we evaluated the presence of HHV DNA in blood samples obtained at the time of hospitalization from 71 patients with acute coronary syndrome, 26 patients with stable coronary artery disease, and 53 healthy volunteers and in atherosclerotic plaques of 22 patients with peripheral artery disease who underwent endarterectomy. HHV‐5 (cytomegalovirus [CMV]) was the only HHV with a level that was higher in acute coronary syndrome patients than in the control group and that correlated with the level of high‐sensitivity C‐reactive protein. The numbers of effector memory T cells positively correlated with the numbers of CMV genome copies in carotid arteries plaques, whereas the numbers of central memory T cells negatively correlated with CMV copy numbers.ConclusionsOf all HHV levels, only CMV was higher in patients with stable coronary artery disease and acute coronary syndrome than in the healthy group, and its load correlated with the level of high‐sensitivity C‐reactive protein. The level of CMV in atherosclerotic plaques correlated with the state of immunoactivation of lymphocytes in plaques, suggesting that the reactivation of CMV may contribute to the immune activation associated with the progression of atherosclerosis.

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C-Reactive Protein, a Sensitive Marker of Inflammation, Predicts Future Risk of Coronary Heart Disease in Initially Healthy Middle-Aged Men

Cited by 1,739 publications

References 43 publications

C‐Reactive Protein Identifies Low‐Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer–Norfolk Prospective Population Study

C‐Reactive Protein Identifies Low‐Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer–Norfolk Prospective Population Study

Low-carbohydrate and high-fat intake among adult patients with poorly controlled type 2 diabetes mellitus

Cytomegalovirus‐Productive Infection Is Associated With Acute Coronary Syndrome

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