Metabolic syndrome, C-reactive protein, and prognosis in patients with established coronary artery disease

Aguilar, David; Fisher, Marian R.; O’Connor, Christopher M.; Dunne, Michael; Muhlestein, Joseph B.; Yao, Louis; Gupta, Sandeep; Benner, Rebecca J.; Cook, Thomas D.; Edwards, Dearborn; Pfeffer, Marc A.

doi:10.1016/j.ahj.2005.11.011

Cited by 43 publications

(29 citation statements)

References 33 publications

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“…Experimental and observational evidence suggests that inflammation may play a central role in the pathogenesis of cardiovascular disease 8. CRP is associated with all parameters of the MS9 and has been acknowledged to be an independent but not causal2, 10 risk factor for incident CHD and to add prognostic value for CHD risk on top of the MS criteria 3, 9, 11, 12, 13, 14…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…3,4 High hsCRP, 5,6 high Nt-proBNP, 7 high UACR 8 and MetS 9,10 have all been demonstrated to predict cardiovascular (CV) events in the general population. However, the interrelations between these factors are complex.…”

Section: Introductionmentioning

confidence: 99%

Impact of the metabolic syndrome on the predictive values of new risk markers in the general population

et al. 2008

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Although the metabolic syndrome (MetS) is positively associated with high-sensitivity C-reactive protein (hsCRP), negatively associated with N-terminal probrain natriuretic peptide (Nt-proBNP) and inconsequently related to urine albumin/creatinine ratio (UACR) they are all associated with cardiovascular events. Therefore, we wanted to determine the influence of MetS on the predictive values of UACR, hsCRP and Nt-proBNP. On the basis of the definition of MetS by the International Diabetes Federation, a Danish population sample of 1983 apparently healthy subjects was divided into three groups: 530 subjects without any elements of MetS, 1093 subjects with some elements of MetS and 360 subjects with MetS. During the following 9.5 years the composite end point of cardiovascular death, nonfatal myocardial infarction or stroke (composite cardiovascular end point, CEP) occurred in 204 subjects. In Cox-regression analyses adjusting for age, gender and smoking, all three cardiovascular risk markers predicted CEP independently of MetS. Despite no significant interaction with MetS, high log(hsCRP) was associated with CEP primarily in subjects without any elements of MetS (hazard ratio (HR) ¼ 4.5 (1.5-14.0), Po0.01), log(NtproBNP) primarily in subjects with some elements of MetS (HR ¼ 3.0 (1.6-5.6), Po0.01), and logUACR independently of elements of MetS. Pre-specified genderadjusted (men/women) cutoff values of hsCRPX6.0/ 7.3 mg l À1 predicted CEP in subjects without elements of MetS with positive and predictive values of 11.5 and 98%, respectively. UACRX0.73/1.06 mg mmol À1 predicted CEP in subjects with MetS with positive and predictive values of 23.5 and 93%, respectively. In apparently healthy subjects, high hsCRP was associated with CEP primarily in subjects without MetS, high Nt-proBNP in subjects with elements of MetS and UACR independently of MetS.

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“…Each of the components of the metabolic syndrome has been independently associated with vascular dysfunction (4)(5)(6)(7)(8). In addition to insulin resistance, release of proinflammatory cytokines (e.g., interleukin-6, tumor necrosis factora) by visceral adipose tissue or other as yet undefined factors may also contribute to vascular dysfunction (9) or adverse clinical outcomes (10,11) in patients with the metabolic syndrome. However, they do not together fully explain the 2.6-fold increased risk of coronary death among those with the metabolic syndrome (12), suggesting that other mechanisms may contribute to the association between the metabolic syndrome and the increased risk of CAD.…”

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confidence: 99%

Coronary Circulatory Function in Patients with the Metabolic Syndrome

Carli¹,

Charytan²,

McMahon³

et al. 2011

J Nucl Med

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The metabolic syndrome affects 25% of the U.S. population and greatly increases the risk of diabetes and coronary artery disease (CAD). We tested the hypothesis that the metabolic syndrome is associated with impaired coronary vasodilator function, a marker of atherosclerotic disease activity. Methods: Four hundred sixty-two patients at risk for CAD, as defined by a low-density lipoprotein cholesterol $ 160 mg/dL with fewer than 2 coronary risk factors, a low-density lipoprotein cholesterol $ 130 mg/dL with 2 or more coronary risk factors, or with documented CAD were included. A subset of 234 individuals underwent repeated PET at 1 y. Myocardial blood flow (MBF) and vasodilator reserve were assessed by PET. Modified criteria of the National Cholesterol Education Program, Adult Treatment Panel III were used to characterize the metabolic syndrome. Results: Adenosine-and cold-stimulated MBF were similar in patients with and without metabolic syndrome, whereas baseline MBF showed a stepwise increase with increasing features of the syndrome. Consequently, patients with metabolic syndrome showed a lower coronary flow reserve (CFR) (2.5 6 1.0) than those without metabolic syndrome (3.0 6 0.9, P 5 0.004). Differences in CFR were no longer present after correcting rest flows for the rate-pressure product. Change in MBF and CFR at 1 y were not different across groups of patients with increasing features of the metabolic syndrome. Conclusion:Patients with metabolic syndrome demonstrate impaired CFR, which is related to the augmentation in resting coronary blood flow caused by hypertension. In high-risk individuals, peak adenosine-and cold-stimulated blood flows are impaired even in the absence of the metabolic syndrome.

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Metabolic syndrome, C-reactive protein, and prognosis in patients with established coronary artery disease

Cited by 43 publications

References 33 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

Impact of the metabolic syndrome on the predictive values of new risk markers in the general population

Coronary Circulatory Function in Patients with the Metabolic Syndrome

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