High Sensitive C-Reactive Protein as a Pro-inflammatory marker for the components of metabolic syndrome
Abstract
Background:Metabolic Syndrome (MS) is a clinical entity characterized by the cluster of insulin resistance, glucose intolerance, atherogenic lipid profile, hypertension, abdominal obesity.CRP (C- reactive protein) is an acute-phase reactant and nonspecific marker of inflammation, produced predominantly in hepatocytes as a pentamer of identical subunits in response to several cytokines. The CRP in plaque deposition is highly complex, exerting pro-atherogenic effects in many cells involved in atherosclerosis.
Materials and Methods:A cross sectional study was conducted by Department of Internal Medicine of Government Thanjavur Medical College Hospital, Thanjavur, Tamilnadu, South India, a tertiary care centre catering to rural population. A total of hundred patients were included in the study. The components of metabolic syndrome were defined according to the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria and World Health Organization (WHO) guidelines for South Asians.According to the guidelines, hs-CRP level of less than 1.0 mg/L is considered as low risk, 1.0 to 3.0 mg/L as moderate risk, and greater than 3.0 mg/L as high risk. Blood sample was drawn in the morning after 10 hours of fasting, to measure venous plasma glucose, serum total cholesterol, serum high density lipoprotein (HDL) cholesterol,serum triglyceride levels (TG) and hsCRP.
Results:A highly positive correlation was established between hS-CRP and all the components of metabolic syndrome except for HDL cholesterol which showed a negative correlation. A univariate type of analysis had shown a statistically significant association between hsCRP and the metabolic syndrome components. The result further showed that hS-CRP level was found to be 1.12mg/dl when only one component of metabolic syndrome was present, whereas the mean level had raised to 2.89mg/dl when all the five components of metabolic syndrome was present.
Conclusion:Hence hs- CRP can probably be used as a surrogate marker of chronic inflammation in patients with metabolic syndrome and the patients with high hsCRP should primarily be targeted with life style modification at an early age, treatment with low dose aspirin and lipid lowering medications before it culminates in overt CVD.
Downloads
References
2. Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries.J ClinEndocrinolMetab. 2008 Nov;93(11 Suppl 1):S9-30. doi: 10.1210/jc.2008-1595.
3. Das M, Pal S, Ghosh A. Prevalence of cardiovascular disease risk factors by habitat: A study on adult Asian Indians in West Bengal, India. AnthropolAnz. 2011;68(3):253-64.
4. Kanjilal S, Shanker J, Rao VS, Khadrinarasimhaih NB, Mukherjee M, Iyengar SS. Prevalence and component analysis of metabolic syndrome: an Indian atherosclerosis research study perspective. Vasc Health Risk Manag. 2008;4(1):189-97
5. Sookoian S, Pirola C. Metabolic syndrome: from the genetics to the pathophysiology. CurrHypertens Rep 2011; 13 (2): 149–157.doi: 10.1007/s11906-010-0164-9.
6. Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, BrenerSJetal.. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA2003;290 (7):898–904.
7. Norata GD, Marchesi P, PulakazhiVenu, Pasqualini F, Anselmo A, Moalli F, et al. Deficiency of the long pentraxin PTX3 promotes vascular inflammation and atherosclerosis. Circulation 2009;120 (8):699–708.doi: 10.1161/CIRCULATIONAHA.108.806547.
8.Libby P. Inflammation in atherosclerosis. Nature 2002;420 (6917):868–74.
9. Zhang YX, Cliff WJ, Schoefl GI, Higgins G. Coronary C-reactive protein distribution: its relation to development of atherosclerosis. Atherosclerosis 1999;145(2):375–9.
10. Libby P, Nahrendorf M, Pittet MJ, Swirski FK. Diversity of denizens of the atherosclerotic plaque: not all monocytes are created equal. Circulation 2008;117(25):3168–70. doi: 10.1161/CIRCULATIONAHA.108.783068
11. Kones R. Primary prevention of coronary heart disease: integration of new data, evolving views, revised goals, and role of rosuvastatin in management. A comprehensive survey. Drug Des DevelTher 2011;5: 325–80.doi: 10.2147/DDDT.S14934.
12. Pepys, MB, Hirschfield, GM. C-reactive protein: a critical update. JClin Invest 2003; 111(12): 1805-12.
13. Fröhlich M, Imhof A, Berg G, Hutchinson WL, Pepys MB, Boeing H, etal. Association between C reactive protein and features of the metabolic syndrome.Diabetes Care 2000; 23 (12): 1835-9.
14. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285 (19): 2486-97.
15. Alberti, KG, Zimmet, P, Shaw, J. The metabolic syndrome – a new worldwide definition. Lancet 2005; 366 (9491): 1059-62.
16. Shishehbor, M.H.; Bhatt, D.L.; Topol, E.J. Using C-reactive protein to assess cardiovascular disease risk. Cleve Clin. J. Med. 2003; 70 (7): 634–640.
17. Suzuki T, Voeks J, Zakai N.A,Jenny NS, Brown TM, Safford MM, et al. Metabolic syndrome, C-reactive protein, and mortality in U.S. Blacks and Whites: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Diabetes Care. 2014;37(8): 2284–2290. doi: 10.2337/dc13-2059.
18. Sattar N, Gaw A, Scherbakova O,Ford I, O'Reilly DS, HaffnerSM,etal. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study.Circulation2003; 108(4): 414-19.
19. Rutter MK, Meigs JB, Sullivan LM, D'Agostino RB Sr, Wilson PW.C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study.Circulation2004;110(4): 380-5.
20. Ramachandran A, Snehalatha C, SatyavaniK,Sivasankari S, Vijay V. Metabolic syndrome in urban Asian Indians adults: a population study using modified ATP III criteria. Diab Res ClinPract2003; 60(3): 199-204.
21. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: TheJNC VII Report 2003; 289(19): 2560-71.
22. Gupta R, Deedwania PC, Gupta A, Rastogi S, Panwar RB, Kothari K. Prevalence of metabolic syndrome in an Indian urban population.Int J Cardiol2004; 97(2): 257-61.
23. SudhaVidyasagar, UK Abdul Razak, CK Prashanth, D MuralidharVarma, KL Bairy.Highly sensitive C-reactive protein in metabolic syndrome.JIACM 2013; 14(3-4): 230-4.
24. Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome and risk of incident cardiovascular events: An 8 year follow-up of 14719 initially healthy American women. Circulation 2003;107(3):391-7.
25. Malik S, Wong ND, Franklin S, Pio J, Fairchild C, Chen R. Cardiovascular disease in U.S. patients with metabolic syndrome, diabetes and elevated c-reactive protein. Diabetes Care 2005;28(3):690-3.
26. Vikram NK, Misra A, Pandey RM, Dwivedi M, Luthra K, Dhingra V, et al. Association between subclinical inflammation and fasting insulin in urban young adult north Indian males. Indian J Med Res 2006;124(6):677-82.
27. Mukta N Chowta, Prabha M Adhikari, RishavSinha, Sahana D Acharya, HN Gopalakrishna, John T Ramapuram. Annals of Tropical Medicine and Public Health. 2012. 5(2). 98 – 102.
28. Pitsovas C,Panagiotakos DB, Tzima N, Lentzas Y, Chrysohoou C, Das UN, etal. Diet, exercise and CRP levels in people with abdominal obesity: the ATTICA epidemiological study. Angiology 2007; 58(2): 225- 33.
29. Miller WM, Memon I, Nori-Janosz KE et al. hs-CRP in the morbidly obese: A predictor of conventional cardiovascular risk factors? Proceedings of 46th annual conference on cardiovascular disease epidemiology and prevention.Circulation2006; 113: E351.
30. Blake GJ, Rifai N, Buring JE, Ridker PM. Blood pressure, CRP and risk of future cardiovascular events. Circulation 2003; 108(24): 2993-9.
31. Picardi A, Valorani MG, VespasianiGentilucci, Manfrini S, Ciofini O, CappaM,etal. Raised CRP levels in patients with recent onset type 1 diabetes.DiabetesMetab.Res Rev 2007; 23(3): 211-4.
32. Schillaci G, Pirro M. C-reactive protein in hypertension: clinical significance and predictive value. NutrMetabCardiovasc Dis 2006;16 (7): 500-8.
33. Doi Y, Kiyohara Y, Kubo M, Ninomiya T, Wakugawa Y, Yonemoto K, etal. Elevated C-reactive protein is a predictor of the development of diabetes in a general Japanese population-The Hisayama Study. Diabetes Care 2005; 28(10): 2497-500.
34. Steven M. Haffner SM. The metabolic syndrome: inflammation, diabetes mellitus, and cardiovascular disease. Am J Cardiol2006; 97(Suppl): 3A-11A.
35. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA,etal. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112(17): 2735-52.
OAI - Open Archives Initiative
