Combined Effects of Inflammatory Status and Carotid Atherosclerosis

Abstract

Background and Purpose— Inflammatory responses play a key role in atherogenesis. The aim of this study was to assess the prognostic value of hsCRP (high-sensitivity C-reactive protein) and to evaluate whether degree of carotid stenosis and serum levels of hsCRP jointly predict long-term mortality in asymptomatic patients with carotid atherosclerosis. Methods— One thousand sixty-five patients with neurological asymptomatic carotid atherosclerosis as evaluated by duplex sonography were prospectively followed for cause-specific mortality. Results— During a median of 11.81 years, a total of 549 deaths, including 362 cardiovascular deaths, were recorded. The risk of all-cause and cardiovascular mortality significantly increased in patients with elevated serum levels of hsCRP (the adjusted hazard ratio for cardiovascular mortality per increase of 1 mg/dL of hsCRP levels was 1.47; P <0.001). Patients with a high degree of carotid stenosis and increased hsCRP levels were particularly at risk of adverse outcome. Patients with carotid narrowing over 50% and hsCRP levels >0.29 mg/dL (=median) had nearly twice as high a risk of cardiovascular mortality compared with patients with carotid stenosis of <50% and hsCRP levels <0.29 mg/dL (adjusted hazard ratio 1.89; P <0.001). Improvement in risk stratification with combined assessment of carotid stenosis and hsCRP was confirmed by an improvement of the continuous net reclassification improvement with 18% for all-cause mortality and 15% for cardiovascular mortality compared with the degree of carotid stenosis alone ( P <0.01). Conclusions— Measurement of hsCRP in combination with ultrasound investigations of the carotid arteries at a single time point provides additional prognostic information for patients with asymptomatic carotid atherosclerosis.

PCSK9 inhibition and inflammation: A narrative review

“…At another arterial site, i.e. the carotid artery, in neurologically asymptomatic patients, narrowing of > 50% associated with elevated hs-CRP gave the best prognostic information [90]. Evaluation of the coronary wall thickness by a similar ultrasound method, together with hs-CRP, may offer a useful non invasive approach to the determination of CV risk [91].…”

Review of serum biomarkers in carotid atherosclerosis

“…That risk was level response associated and patients with carotid narrowing of greater than 50% and hs-CRP levels of greater than 0.29 mg/dL had nearly twice as high a risk of cardiovascular mortality compared with patients with carotid stenosis of less than 50% and hs-CRP levels of less than 0.29 mg/dL. 13 This association with carotid disease, however, is also controversial. Some studies suggest that high serum hs-CRP levels can predict the presence of carotid plaque, [14][15][16] although other studies could not establish that association 17,18 or any correlation with the degree of stenosis.…”

New insight into biology, molecular diagnostics and treatment options of unstable carotid atherosclerotic plaque: a narrative review

“…There are numerous inflammatory biomarkers which levels are increased in patients with carotid stenosis and the link between elevated inflammatory markers and atherosclerotic plaque destabilization has also been demonstrated (21). The best validated are: highsensitivity C-reactive protein (hsCRP), interleukins (IL-6, IL-1B, IL-8, IL-10), soluble Vascular Cell Adhesion Molecule-1 (sVCAM), osteopontin, serum amyloid A (SAA), (21)(22)(23)(24). Especially MMP-9, produced by activated macrophages, which is able to destroy the extracellular matrix is believed to be a promising marker of unstable plaque.…”