Mediation analysis for the relationship between dyslipidemia and coronary artery disease via hypersensitive C-reactive protein in a case-control study

Abstract

Background The pathological basis of coronary artery disease (CAD) is atherosclerosis which is associated with inflammation and dyslipidemia. However, the involvement of hypersensitive C-reactive protein (hs-CRP) in lipid metabolism and how it affects the pathogenesis of CAD is uncertain. Objective To explore whether the relationship between dyslipidemia and CAD is partly mediated by hs-CRP levels. Methods Three hundred fifteen pairs of randomly sexand age-matched CAD and non-CAD subjects collected from Zhongda Hospital Affiliated to Southeast University were involved in the final analysis. We gathered information about each subjects clinical history as well as their results of detected hs-CRP and lipid levels. Linear regression analysis was used to determine the association between dyslipidemia and hs-CRP levels in which univariate and multivariate logistic regression analyzes were performed to determine the relationship between hs-CRP levels and CAD as well as dyslipidemia and CAD. Mediation analysis was used to evaluate whether hs-CRP levels act as a mediator of the relationship between dyslipidemia and CAD. Results Dyslipidemia and hs-CRP levels were significantly associated with an increased risk of CAD, with β = 0.594 (P = 0.001) and β = 0.016 (P = 0.024), respectively, and there was a correlation between dyslipidemia and hs-CRP levels (β = 3.273, P = 0.004). Mediation analysis results revealed that the correlation between dyslipidemia and CAD was 8.27% mediated by hs-CRP levels with a direct effect of 0.621 and an indirect effect of 0.056. Conclusion Hs-CRP levels played a partial mediation role in the association between dyslipidemia and CAD.

CRP Serum Levels Are Associated with High Cardiometabolic Risk and Clinical Disease Activity in Systemic Lupus Erythematosus Patients

“…The relationship between CRP and dyslipidemia could be explained by excessive lipids accumulating in the arterial wall, inducing an inflammatory response; it accelerates lipid deposition and amplifies the inflammation producing inflammatory factors such as CRP [ 34 ]. CRP can bind to LDL-C in atherosclerotic plaques, leading to complement activation, and promoting inflammation and atherosclerosis.…”

“…CRP can bind to LDL-C in atherosclerotic plaques, leading to complement activation, and promoting inflammation and atherosclerosis. Pan He et al reported that CRP plays a mediator role in the relationship between dyslipidemia and coronary arterial disease [ 34 ]. On the other hand, in normal conditions HDL-C promotes reverse cholesterol transport and inhibits LDL-C oxidation; however, under inflammatory conditions characterized by high levels of inflammatory markers such as IL-6, the antioxidant and anti-atherogenic capacity of HDL-C may be lower.…”

High-Sensitivity C-Reactive Protein to HDL-C Ratio

“…The mediation analysis revealed that hs-CRP played a partial mediating role in the relationship between dyslipidemia and CAD (8.27%). 6) To the best our knowledge, however, no study has directly combined HDL-C and hsCRP, two biological indicators, to explore the severity of CAD. In our work, we assumed that the CHR was a biomarker composed of inflammation marker and lipid cholesterol marker.…”

“…4,5) Recent studies suggested that that 8.27% of coronary artery disease with dyslipidemia is mediated by hsCRP levels. 6) However, no study has directly combined HDL-C and hsCRP, two biological indicators, to explore the severity of coronary artery disease. Therefore, this study suggested that hsCRP as a marker of the pro-inflammatory state and HDL-C as an anti-atherosclerosis component should be integrated into a single biomarker CHR in order to explore the correlation of CHR with the CAD severity and to predict the severity of coronary artery stenosis among CAD patients.…”

Hypersensitive C-reactive Protein to HDL-C Ratio Predicts the Severity of Coronary Artery Disease

“…Hs-CRP and HDL-C are both important in the process of atherosclerosis. Recent studies had suggested that the in uence of coronary heart disease by 8.27% with dyslipidemia was mediated by the hs -CRP levels 4 .…”