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• W1964902008 abstract "HomeCirculationVol. 100, No. 15C-Reactive Protein, Serum Amyloid A Protein, and Coronary Events Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBC-Reactive Protein, Serum Amyloid A Protein, and Coronary Events Robin P. Choudhury and Francisco Leyva Robin P. ChoudhuryRobin P. Choudhury Department of Cardiology, Royal Brompton Hospital, London, UK Search for more papers by this author and Francisco LeyvaFrancisco Leyva Department of Cardiology, Royal Brompton Hospital, London, UK Search for more papers by this author Originally published12 Oct 1999https://doi.org/10.1161/01.CIR.100.15.e65Circulation. 1999;100:e65To the Editor:Ridker et al1 examined C-reactive protein (CRP) and serum amyloid A protein (SAA) in patients from CARE, a secondary-prevention study of pravastatin after myocardial infarction. They observed that the median plasma concentrations of CRP (0.31 versus 0.28 mg/dL; P=0.05) and SAA (0.34 versus 0.28 mg/dL; P=0.006) were significantly higher among those in whom coronary events occurred than in age- and sex matched controls. They concluded that the plasma concentrations of CRP and SAA predict the risk of recurrent coronary events among patients with prior myocardial infarction.However, the matching of the subjects and controls was not complete. The group in whom events occurred contained a significantly higher proportion of diabetic patients (22.3% versus 9.7%; P=0.001), who are known to be at high risk of coronary events.2We investigated 23 diabetic patients (mean age 62.0 years, SD 10.3, range 42 to 76; 18 men, 5 women) and 33 nondiabetic controls (61.3 years, SD 9.2, range 39 to 86; 31 men, 2 women), all with similar symptoms of stable angina and angiographically confirmed coronary disease. There were no significant differences between the groups in the mean number of affected coronary vessels (2.47 in diabetic and 2.21 in controls) or in history of hypertension, smoking, total cholesterol, cholesterol subfractions, or use of statins and aspirin. However, we found that the diabetic patients had significantly higher plasma concentrations of both CRP (mean, SD of log values 2.78, −0.60, +0.77 versus 1.52, −1.00, +2.92 mg/L, P=0.05) and SAA (mean, SD of log values 2.33, −1.52, +4.38 versus 1.15, −0.86, +3.38 mg/L, P=0.042). The values of these analytes were highly skewed, as usual, but were normalized by log transformation and were then subjected to a 1-way ANOVA.In view of these findings, it is possible that higher levels of CRP and SAA observed by Ridker et al may have been due to an excess of diabetic patients in the event group. Larger studies will establish the role of CRP and SAA as predictors of future events in diabetic patients. The inflammatory response may be an important factor in the predisposition to atherothrombotic events in diabetes. The stimuli responsible for the acute-phase response in higher-risk atherosclerosis patients may arise from more severe, extensive, or unstable arterial lesions and/or from inflammation or low-grade infection elsewhere. References 1 Ridker PM, Rifai N, Pfeffer MA, Sacks FM, Moye LA, Goldman S, Flaker GC, Braunwald E, for the Cholesterol and Recurrent Events (CARE) Investigators. Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Circulation.1998; 98:839–844.CrossrefMedlineGoogle Scholar2 Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med.1998; 339:229–234.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Tanaka S, Couret D, Tran-Dinh A, Duranteau J, Montravers P, Schwendeman A and Meilhac O (2020) High-density lipoproteins during sepsis: from bench to bedside, Critical Care, 10.1186/s13054-020-02860-3, 24:1, Online publication date: 1-Dec-2020. Frej C, Mendez A, Ruiz M, Castillo M, Hughes T, Dahlbäck B and Goldberg R (2017) A Shift in ApoM/S1P Between HDL-Particles in Women With Type 1 Diabetes Mellitus Is Associated With Impaired Anti-Inflammatory Effects of the ApoM/S1P Complex, Arteriosclerosis, Thrombosis, and Vascular Biology, 37:6, (1194-1205), Online publication date: 1-Jun-2017. Rosenson R, Brewer H, Ansell B, Barter P, Chapman M, Heinecke J, Kontush A, Tall A and Webb N (2015) Dysfunctional HDL and atherosclerotic cardiovascular disease, Nature Reviews Cardiology, 10.1038/nrcardio.2015.124, 13:1, (48-60), Online publication date: 1-Jan-2016. Santos-Gallego C, Badimon J and Rosenson R (2014) Beginning to Understand High-Density Lipoproteins, Endocrinology and Metabolism Clinics of North America, 10.1016/j.ecl.2014.08.001, 43:4, (913-947), Online publication date: 1-Dec-2014. Santos-Gallego C and Rosenson R (2014) Role of HDL in Those with Diabetes, Current Cardiology Reports, 10.1007/s11886-014-0512-5, 16:9, Online publication date: 1-Sep-2014. Poręba R, Poręba M, Gać P, Steinmetz-Beck A, Beck B, Pilecki W, Andrzejak R and Sobieszczańska M (2011) Electrocardiographic Changes in Workers Occupationally Exposed to Lead, Annals of Noninvasive Electrocardiology, 10.1111/j.1542-474X.2010.00406.x, 16:1, (33-40), Online publication date: 1-Jan-2011. (2011) Epidemiology High-Density Lipoproteins, 10.1002/9781118158678.ch5, (113-160) Dogan S and Atakan N (2010) Is serum amyloid A protein a better indicator of inflammation in severe psoriasis?, British Journal of Dermatology, 10.1111/j.1365-2133.2010.09907.x, 163:4, (895-896), Online publication date: 1-Oct-2010. Kontush A and Chapman M (2008) Why is HDL functionally deficient in type 2 diabetes?, Current Diabetes Reports, 10.1007/s11892-008-0010-5, 8:1, (51-59), Online publication date: 1-Feb-2008. Yagi T and Scheinman M (2007) Coronary Sinus Activation Pattern in Patients with Atrioventricular Nodal Reentrant Tachycardia, Journal of Arrhythmia, 10.1016/S1880-4276(07)80013-5, 23:1, (25-34), . Kling M, Alesci S, Csako G, Costello R, Luckenbaugh D, Bonne O, Duncko R, Drevets W, Manji H, Charney D, Gold P and Neumeister A (2007) Sustained Low-Grade Pro-inflammatory State in Unmedicated, Remitted Women with Major Depressive Disorder as Evidenced by Elevated Serum Levels of the Acute Phase Proteins C-reactive Protein and Serum Amyloid A, Biological Psychiatry, 10.1016/j.biopsych.2006.09.033, 62:4, (309-313), Online publication date: 1-Aug-2007. Kontush A and Chapman M (2006) Functionally Defective High-Density Lipoprotein: A New Therapeutic Target at the Crossroads of Dyslipidemia, Inflammation, and Atherosclerosis, Pharmacological Reviews, 10.1124/pr.58.3.1, 58:3, (342-374), Online publication date: 1-Sep-2006. Frohlich J, Dobiasova M, Lear S and Lee K (2008) The Role of Risk Factors in the Development of Atherosclerosis, Critical Reviews in Clinical Laboratory Sciences, 10.1080/20014091084245, 38:5, (401-440), Online publication date: 1-Jan-2001. October 12, 1999Vol 100, Issue 15 Advertisement Article InformationMetrics Copyright © 1999 by American Heart Associationhttps://doi.org/10.1161/01.CIR.100.15.e65 Originally publishedOctober 12, 1999 PDF download Advertisement" @default.
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