Independent Prognostic Value of Elevated C-Reactive Protein in Unstable Angina

Ferreirós, Ernesto; Boissonnet, Carlos; Pizarro, Rodolfo; Merletti, Pablo F. García; Corrado, Gianni; Cagide, Arturo; Bazzino, Oscar

doi:10.1161/01.cir.100.19.1958

Cited by 199 publications

(123 citation statements)

References 22 publications

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“…Several epidemiological studies have identified IL-6 and C-reactive protein (CRP) as predictors of general morbidity in the elderly. 4 IL-6 and CRP are prognostic factors in unstable angina 5,6 and are associated with cardiovascular and all-cause mortality. 7 Visser et al showed in a large epidemiological study that overweight adults have constitutively elevated serum CRP concentration.…”

Section: Introductionmentioning

confidence: 99%

Hormonal regulation of interleukin-6 production in human adipocytes

et al. 2002

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OBJECTIVE:To elucidate the hormonal regulation of interleukin-6 (IL-6) production by human adipose tissue and its relation to leptin. DESIGN: In vitro study. Human adipocytes were incubated with dexamethasone (with or without RU486), norepinephrine and epinephrine (with or without propranolol), or insulin. MEASUREMENTS: IL-6 and leptin secretion by human adipocytes. RESULTS: A gradual increase in IL-6 secretion by adipocytes during differentiation was observed. A positive correlation was found between basal IL-6 release and both glycerol 3-phosphate dehydrogenase activity -a marker of adipocyte differentiation -and leptin release. Dexamethasone decreased IL-6 secretion and increased leptin secretion in a dose-dependent manner. Both catecholamines increased IL-6 and leptin secretion. The effects of dexamethasone and catecholamines on IL-6 and leptin were abrogated by RU486 and propranolol, respectively. Incubation with insulin resulted in a dose-dependent stimulation of IL-6 and leptin secretion. CONCLUSION: IL-6 is produced by human adipocytes and is a potential marker of adipocyte differentiation. Furthermore it is a hormonally regulated cytokine, suppressed by glucocorticoids, and stimulated by catecholamines and insulin in physiological concentrations.

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Section: Introductionmentioning

confidence: 99%

Hormonal regulation of interleukin-6 production in human adipocytes

et al. 2002

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“…Nineteen studies were selected; 15 were carried out by North American or European groups 1,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] , three by Brazilian groups [28][29][30] and one by an Argentinean group 31 . All these studies were published in journals with an impact factor ≥ 3, except for two Brazilian studies 28,29 .…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…The sample size of the studies increased throughout the years, ranging from 32 to 7,108 patients (mean of 1,123 ± 1,674); seven studies had more than 1,000 patients 20,21,[23][24][25][26][27] , in a total of 21,339 patients studied. C-reactive protein was measured in all studies by means of a high-sensitivity method; 11 used nephelometry [14][15][16][17][18][19][21][22][23][24]26,[28][29][30] , three used turbidimetry 1,25,27 , one used luminometry 20 , and two used ELISA (Enzyme Liked Immunosorbent Assay) 31 .…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…Meta-analytic approach was used with the 12 studies which compared the incidence of events between two dichotomous groups according to the level of C-reactive protein [14][15][16][17]19,20,[25][26][27][29][30][31] . Duarte et al's study 28 was not included in this analysis because it assessed C-reactive protein as a continuous variable.…”

Section: Figura 3 -Summary Roc Curve Of the Association Of The Differmentioning

confidence: 99%

“…First, the form of determination of the cut-off point for C-reactive protein: four studies identified the cut-off point by using the ROC curve 19,26,30,31 and other eight studies chose the cut-off point arbitrarily [14][15][16][17]20,25,27,29 . According to the meta-regression analysis, the form of determination of the cut-off point had no influence on the study results (OR = 1.34; 95% CI = 0.52 -3.47; p = 0.49).…”

Section: Analysis Of Sensitivity: Short-term Prediction Of Eventsmentioning

confidence: 99%

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Proteína C-reativa e prognóstico em síndromes coronarianas agudas: revisão sistemática e metanálise

Correia¹,

Esteves²

2011

Arq. Bras. Cardiol.

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Despite the association between high-sensitivity C-reactive protein (CRP) and recurrent events in non-ST elevation acute coronary syndromes (ACS), routine determination of this marker has not been recommended.In order to verify whether the current scientific evidence justifies the inclusion of CRP for risk stratification at hospital admission of patients with ACS, we carried out a systematic review and meta-analysis of the studies indexed in MEDLINE, SciELO or LILACS, with the following inclusion criteria: prospective cohort design and assessment of the prognostic value of CPR, as measured using a high-sensitivity method at the moment of hospital admission of patients with ACS. Nineteen studies met the inclusion criteria.In relation to the long-term follow-up, there was a consistent association between CRP and cardiovascular events, with an overall odds ratio (OR) of 4.6 (95% CI = 2.3 -7.6) and overall multivariate OR of 2.5 (95% CI = 1.8-3.4). As for the short-term, nine studies were positive and six were negative, with an overall OR of 1.65 (95% CI = 1.2-2.3). The overall multivariate OR was not obtained for the short-term follow-up, because this measurement was described only in three heterogeneous studies. Only two short-term studies analyzed the incremental predictive value of CRP in relation to multivariate models, with contradicting results.In conclusion, the small number of assessments of the incremental value of CRP, in conjunction with controversial results regarding the independent predictive value of CRP for short-term events does not support the recommendation of the routine use of CRP for risk stratification at admission of patients with ACS.

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Association of platelet‐monocyte aggregates with platelet activation, systemic inflammation, and myocardial injury in patients with non‐st elevation acute coronary syndromes

Zhang

Jin

Qin

et al. 2007

Clinical Cardiology

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SummaryBackground: Platelet-monocyte aggregates (PMA) and C-reactive protein (CRP) are increased in unstable coronary disease. The interrelation of PMA with platelet activation, systemic inflammation, and their association with markers of myocardial injury has not been studied extensively.Hypothesis: The study was undertaken to evaluate the association of CRP, PMA, and cardiac troponin I (cTnI) in patients admitted with non-ST elevation acute coronary syndromes (NSTE-ACS).Methods: In all, 69 consecutive patients with NSTE-ACS, 58 patients with stable angina pectoris (SAP), and 46 control patients without coronary artery disease were selected; PMA, sP-selectin, sCD40L inter leukin, (IL)-6, CRP, and cTnI concentrations were measured in these patients at the time of admission. Patients with NSTE-ACS were classified into two groups: those with troponin normal (cTnI < 0.06 ng/ml) and those with troponin elevation (cTnI ≥ 0.06 ng/ml). Their risk for clinical inhospital cardiac events (death and nonfatal myocardial infarction) was analyzed.

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Independent Prognostic Value of Elevated C-Reactive Protein in Unstable Angina

Abstract: In unstable angina, CRP is a strong independent marker of increased 90-day risk. Compared with CRP at admission, CRP at discharge is better related to later outcome and could be of great utility for risk stratification.

Cited by 199 publications

References 22 publications

Hormonal regulation of interleukin-6 production in human adipocytes

Hormonal regulation of interleukin-6 production in human adipocytes

Proteína C-reativa e prognóstico em síndromes coronarianas agudas: revisão sistemática e metanálise

Association of platelet‐monocyte aggregates with platelet activation, systemic inflammation, and myocardial injury in patients with non‐st elevation acute coronary syndromes

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