Evaluation of the Relation between Serum Level of High-Sensitivity Reactive Protein (HS-CRP) and Coronary Calcification with the Presence of Coronary Artery Disease in Computed Tomography Angiography

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Some studies showed that two factors of calcium score and high-sensitivity C-reactive protein (HS-CRP) are related with coronary artery disease, but no definitive theory has been provided. The aim of this study was to determine the relationship between serum level of HS-CRP and calcium score with coronary artery disease.Methods: In a cross-sectional study, 200 patients who were candidates for computed tomography (CT) angiography were studied. The level of HS-CRP and coronary artery calcium scores were measured and their correlation with the intensity of coronary artery disease were evaluated.Findings: There was a direct and significant correlation between calcium score and HS-CRP level (r = 0.25, P < 0.001). Multivariate analyzes showed that the odds ratio of coronary artery disease was 3.5 fold more for male sex, 3.7 fold for smokers, 7.6 fold for positive family history, 5.8 fold for high blood pressure, 1.4 fold for calcium scores, 11.8 f fold or high HS-CRP, 1.8 fold for hyperlipidemia.Conclusion: Our results show that HS-CRP level in patients with coronary artery disease is higher than those without coronary artery disease, and there is a direct and significant correlation between this index and calcium scores. HS-CRP seems to be a good indicator for predicting the risk of coronary disease. At the same time, further studies in this field are suggested.

Keywords


  1. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357(3): 266-81.
  2. Zittermann A. Vitamin D and disease prevention with special reference to cardiovascular disease. Prog Biophys Mol Biol 2006; 92(1): 39-48.
  3. Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008; 117(4): 503-11.
  4. Watson KE, Abrolat ML, Malone LL, Hoeg JM, Doherty T, Detrano R, et al. Active serum vitamin D levels are inversely correlated with coronary calcification. Circulation 1997; 96(6): 1755-60.
  5. Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, et al. Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med 2008; 168(12): 1340-9.
  6. Akin F, Ayca B, Kose N, Duran M, Sari M, Uysal OK, et al. Serum vitamin D levels are independently associated with severity of coronary artery disease. J Investig Med 2012; 60(6): 869-73.
  7. Grandi NC, Breitling LP, Vossen CY, Hahmann H, Wusten B, Marz W, et al. Serum vitamin D and risk of secondary cardiovascular disease events in patients with stable coronary heart disease. Am Heart J 2010; 159(6): 1044-51.
  8. Quyyumi AA. Prognostic value of endothelial function. Am J Cardiol 2003; 91(12A): 19H-24H.
  9. Weber T, Auer J, O'Rourke MF, Kvas E, Lassnig E, Berent R, et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation 2004; 109(2): 184-9.
  10. Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002; 110(2): 229-38.
  11. Mantell DJ, Owens PE, Bundred NJ, Mawer EB, Canfield AE. 1 alpha,25-dihydroxyvitamin D(3) inhibits angiogenesis in vitro and in vivo. Circ Res 2000; 87(3): 214-20.
  12. Al M, I, Patel R, Murrow J, Morris A, Rahman A, Fike L, et al. Vitamin D status is associated with arterial stiffness and vascular dysfunction in healthy humans. J Am Coll Cardiol 2011; 58(2): 186-92.
  13. Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupillai N. Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr 2000; 72(2): 472-5.
  14. Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1982; 1(8263): 74-6.
  15. Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet 1997; 349(9050): 462-6.
  16. Kuller LH, Tracy RP, Shaten J, Meilahn EN. Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Multiple Risk Factor Intervention Trial. Am J Epidemiol 1996; 144(6): 537-47.
  17. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336(14): 973-9.
  18. Koenig W, Sund M, Frohlich M, Fischer HG, Lowel H, Doring A, et al. C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation 1999; 99(2): 237-42.
  19. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98(8): 731-3.
  20. Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation 1998; 97(20): 2007-11.
  21. Shah PK. Circulating markers of inflammation for vascular risk prediction: are they ready for prime time. Circulation 2000; 101(15): 1758-9.
  22. Nesar Hossieni V, Mohamadpour R. Relation of inflammatory markers with the intensity of coronary heart disease. J Mazandaran Univ Med Sci 2007; 16(56): 44-52. [In Persian].
  23. El-Ashmawy HM, Roshdy HS, Saad Z, Ahmed AM. Serum endostatin level as a marker for coronary artery calcification in type 2 diabetic patients. J Saudi Heart Assoc 2019; 31(1): 24-31.
  24. Roghani F, Mehrabi KA, Nezarat N, Saleki M. The correlation between early complications of percutaneous coronary intervention and high sensitive C-reactive protein. ARYA Atheroscler 2013; 9(4): 263-7.
  25. Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol 2005; 46(1): 158-65.
  26. Guo J, Erqou SA, Miller RG, Edmundowicz D, Orchard TJ, Costacou T. The role of coronary artery calcification testing in incident coronary artery disease risk prediction in type 1 diabetes. Diabetologia 2019; 62(2): 259-68.