C-reactive protein, carotid intima-media thickness, and incidence of ischemic stroke in the elderly

Cao, Jinxin; Thach, Chau

doi:10.1016/j.accreview.2003.09.013

Cited by 61 publications

(73 citation statements)

References 30 publications

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“…We have previously demonstrated that elevated hs-CRP level was strongly associated with the extent of the atherosclerosis in the carotid arteries, independent of the other known risk factors for atherosclerosis [17]. A similar association between CRP levels and stroke was also shown by Cao et al [28]. In another study with 124 hypertensive patients being managed by drug therapy or lifestyle modification, CRP was also shown as an equivalent or superior independent predictor of the progression of carotid atherosclerosis as compared to pulse pressure or systolic blood pressure [29].…”

Section: Discussionsupporting

confidence: 76%

Antihypertensive Drugs and Inflammation in Acute Ischemic Stroke as a Predictor Factor of Future Cardiovascular Mortality

et al. 2011

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The beneficial effects of antihypertensive drugs in secondary stroke prevention could not be based on their effects on lowering hypertension only.In this prospective study, the status of blood pressure, treatment regimens, new atherothrombotic event, blood sampling for hs-CRP and fibrinogen were asked at initial visit, 6th, and 12th months in 226 patients with atherothrombotic stroke.Eighty-seven percent of patients had an antihypertensive regimen, but hypertension control was achieved in 34.1% of patients.Neither use of six different antihypertensive drug regimens nor the change in blood pressure levels showed any difference on new atherothrombotic events, outcomes or survival rates.On the other hand, the higher levels of hs-CRP at baseline were found to be associated with higher mortality rates (p=0.020).Our findings emphasize the predictive role of inflammation in future cardiovascular mortality in patients with acute ischemic stroke, indicating that inflammatory mediators underlying the atherothrombotic process play a more important role than it is assumed.

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Section: Discussionsupporting

confidence: 76%

Antihypertensive Drugs and Inflammation in Acute Ischemic Stroke as a Predictor Factor of Future Cardiovascular Mortality

et al. 2011

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“…Some studies reported elevated CRP to increase the risk for ischemic strokes, [3][4][5] an association that was found to be independent of atherosclerosis severity. 6 So far, it is unclear whether CRP is a risk factor for stroke in general or whether the risk increase can be explained by the associations of CRP with certain stroke subtypes.…”

mentioning

confidence: 99%

C-Reactive Protein, Carotid Atherosclerosis, and Cerebral Small-Vessel Disease

Schmidt

Pichler³

et al. 2006

Stroke

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Background and Purpose-C-reactive protein (CRP) is an inflammatory marker known to be a risk factor for stroke. We examined the associations between CRP, carotid atherosclerosis, white matter lesions, and lacunes as manifestations of cerebral large-and small-vessel disease. Methods-In the community-based Austrian Stroke Prevention Study, CRP concentrations were measured by a highly sensitive assay in 700 participants at baseline. All underwent carotid duplex scanning, and a subset of 505 subjects underwent brain magnetic resonance imaging. Imaging was repeated after 3 and 6 years. We graded carotid atherosclerosis in both common and internal carotid arteries on a 5-point scale and calculated the sum of scores as an index of the severity of carotid atherosclerosis. The volume of white matter lesions and the number of lacunes were considered small vessel disease-related brain abnormalities. Results-After adjustment for vascular risk factors, the severity and progression of extracranial carotid atherosclerosis increased with increasing quintiles of CRP. Only study participants in the fourth and fifth quintile (Ͼ2.50 mg/L) had significantly more baseline atherosclerosis and greater progression when we used the first quintile (Ͻ0.80 mg/L) as a reference. No interactions were seen between CRP quintiles and vascular risk factors for carotid atherosclerosis. The associations between severity and progression of small vessel disease-related brain abnormalities and CRP were nonsignificant. Conclusions-We found evidence for differential effects of CRP in different beds of the arterial brain supply. CRP was a marker for active carotid atherosclerosis but not for small vessel disease-related brain lesions. (Stroke. 2006;37:2910-2916.)

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“…However, the association was rather weak (standardized B = 0.042), so it is not surprising that previous studies on the correlation between hsCRP and IMT yielded inconsistent results. Elevated hsCRP has been shown to correlate with enhanced IMT [25,50] and has been discussed as a possible marker for plaque instability in coronary and carotid territories [4,12,35]. This observation was supported by several other studies on patients with diabetes, metabolic syndrome, dialysis, rheumatoid arthritis, and atherosclerosis [9,18,20,26,28,41,43,52], but could not be confirmed after adjustment for conventional risk factors [16].…”

Section: Discussionmentioning

confidence: 82%

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

et al. 2009

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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.

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C-reactive protein, carotid intima-media thickness, and incidence of ischemic stroke in the elderly

Cited by 61 publications

References 30 publications

Antihypertensive Drugs and Inflammation in Acute Ischemic Stroke as a Predictor Factor of Future Cardiovascular Mortality

Antihypertensive Drugs and Inflammation in Acute Ischemic Stroke as a Predictor Factor of Future Cardiovascular Mortality

C-Reactive Protein, Carotid Atherosclerosis, and Cerebral Small-Vessel Disease

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

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