Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of Serum C-Reactive Protein Levels in Individuals with Different 10-Year Risks of Atherosclerotic Cardiovascular Disease: A Cross-Sectional Study in

Document Type : Original Article(s)

Authors
Mohammad-Shafi Mojadadi 1
Aref Babajanian 2
Ali Gohari 3
Zahra Emami 4
Saeideh Sadat Shobeiri 5
1 Department of Immunology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
2 Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
3 Department of Biochemistry and Nutrition, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
4 Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
5 Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
10.48305/jims.v44.i870.1240
Abstract
Background: C-reactive protein (CRP) is a well-established marker of inflammation. According to previous studies, systemic inflammation is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Therefore, this study aimed to compare serum levels of high-sensitivity CRP (hs-CRP) among individuals with varying ten-year ASCVD risk levels.
Methods: This cross-sectional study was conducted at the PERSIAN Cohort Center in Sabzevar in 2022. Participants were categorized into four risk groups (low, borderline, intermediate, and high) based on their ten-year ASCVD risk, estimated using the ASCVD Risk Calculator developed by the American College of Cardiology. Serum hs-CRP concentrations were measured by sandwich ELISA, and serum levels were compared across risk groups using the Kruskal-Wallis test.
Findings: Among 873 participants with a median age of 55 years (61.4% female), 587 individuals (67.2%) were classified as low risk, 86 (9.9%) as borderline, 172 (19.7%) as intermediate, and 28 (3.2%) as high ASCVD risk. No statistically significant differences were observed in mean serum hs-CRP levels across the different ASCVD risk groups (P > 0.05).
Conclusion: Despite the well-established role of CRP in predicting cardiovascular disease risk, the present study found no significant differences in its serum levels across different ASCVD risk groups. These findings suggest that CRP alone may not be sufficient for precise risk assessment, and that simultaneous evaluation of other inflammatory markers could enhance the identification of high-risk individuals and support the development of more effective interventions.

Highlights

Mohammad-Shafi Mojadadi: Google Scholar ,PubMed

Aref Babajanian: Google Scholar ,PubMed

 Ali Gohari: Google Scholar ,PubMed

Zahra Emami: Google Scholar ,PubMed

Saeideh Sadat Shobeiri: Google Scholar ,PubMed

Keywords
C-reactive protein
Inflammation
Atherosclerosis
Cardiovascular diseases
PERSIAN cohort
Subjects
1.     Ellulu MS, Patimah I, Khaza'ai H, Rahmat A, Abed Y, Ali F. Atherosclerotic cardiovascular disease: a review of initiators and protective factors. Inflammopharmacology 2016; 24(1): 1-10.
2.     Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002; 105(9): 1135-43.
3.     He Z, Luo J, Lv M, Li Q, Ke W, Niu X, et al. Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques. Front Neurol 2023; 14: 1159288.
4.     Ramji DP, Ismail A, Chen J, Alradi F, Al Alawi S. Survey of In Vitro Model Systems for Investigation of Key Cellular Processes Associated with Atherosclerosis. Methods Mol Biol 2022; 2419: 39-56.
5.     Morrison AM, Sullivan AE, Aday AW. Atherosclerotic Disease: Pathogenesis and Approaches to Management. Med Clin North Am 2023; 107(5): 793-805.
6.     Libby P, Buring JE, Badimon L, Hansson GK, Deanfield J, Bittencourt MS, et al. Atherosclerosis. Nat Rev Dis Primers 2019; 5(1): 56.
7.     Libby P, Hansson GK. From Focal Lipid Storage to Systemic Inflammation: JACC Review Topic of the Week. J Am Coll Cardiol 2019; 74(12): 1594-607.
8.     Ngwa DN, Pathak A, Agrawal A. IL-6 regulates induction of C-reactive protein gene expression by activating STAT3 isoforms. Mol Immunol 2022; 146: 50-6.
9.     Kyr M, Fedora M, Elbl L, Kugan N, Michalek J. Modeling effect of the septic condition and trauma on C-reactive protein levels in children with sepsis: a retrospective study. Crit Care 2007; 11(3): R70.
10.  Banait T, Wanjari A, Danade V, Banait S, Jain J. Role of High-Sensitivity C-reactive Protein (Hs-CRP) in Non-communicable Diseases: A review. Cureus 2022; 14(10): e30225.
11.  Shrivastava AK, Singh HV, Raizada A, Singh SK. C-reactive protein, inflammation and coronary heart disease. The Egyptian Heart Journal 2015; 67(2): 89-97.
12.  Pathak A, Singh SK, Thewke DP, Agrawal A. Conformationally Altered C-Reactive Protein Capable of Binding to Atherogenic Lipoproteins Reduces Atherosclerosis. Front Immunol 2020: 11: 1780.
13.  Chang MK, Binder CJ, Torzewski M, Witztum JL. C-reactive protein binds to both oxidized LDL and apoptotic cells through recognition of a common ligand: Phosphorylcholine of oxidized phospholipids. Proc Natl Acad Sci U S A 2002; 99(20): 13043-8.
14.  Zwaka TP, Hombach V, Torzewski J. C-reactive protein-mediated low density lipoprotein uptake by macrophages: implications for atherosclerosis. Circulation 2001; 103(9): 1194-7.
15.  Black S, Kushner I, Samols D. C-reactive Protein. Journal of Biological Chemistry 2004; 279(47): 48487-90.
16.  Kirkgöz K. C-Reactive Protein in Atherosclerosis-More than a Biomarker, but not Just a Culprit. Rev Cardiovasc Med 2023; 24(10): 297.
17.  Scirica BM, Morrow DA. Is C-reactive protein an innocent bystander or proatherogenic culprit? The verdict is still out. Circulation 2006; 113(17): 2128-34; discussion 51.
18.  Ridker PM, Wilson PW, Grundy SM. Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation 2004; 109(23): 2818-25.
19.  Yu H, Rifai N. High-Sensitivity C-Reactive Protein and Atherosclerosis: From Theory to Therapy. Int J Cardiol 2000; 33(8): 601-10.
20.  Kones R. Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease--a perspective. Drug Des Devel Ther 2010; 4: 383-413.
21.  Ghiasi Hafezi S, Sahranavard T, Kooshki A, Hosseini M, Mansoori A, Fakhrian EA, et al. Predicting high sensitivity C-reactive protein levels and their associations in a large population using decision tree and linear regression. Sci Rep 2024; 14(1): 30298.
22.  Ridker PM, Pare G, Parker A, Zee RY, Danik JS, Buring JE, et al. Loci related to metabolic-syndrome pathways including LEPR,HNF1A, IL6R, and GCKR associate with plasma C-reactive protein: the Women's Genome Health Study. Am J Hum Genet 2008; 82(5): 1185-92.
23.  Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347(20): 1557-65 .
24.  Koenig W, Löwel H, Baumert J, Meisinger C. C-reactive protein modulates risk prediction based on the Framingham Score: implications for future risk assessment: results from a large cohort study in southern Germany. Circulation 2004; 109(11): 1349-53.
25.  Ridker PM. Hyperlipidemia as an instigator of inflammation: inaugurating new approaches to vascular prevention. J Am Heart Assoc 2012; 1(1): 3-5.
26.  Shaw LJ. An Approach to Asymptomatic and Atypically or Typically Symptomatic Women with Cardiac Disease. Interv Cardiol Clin 2012; 1(2): 157-63.
27.  Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2010; 56(25): e50-103.
28.  Cook NR, Buring JE, Ridker PM. The effect of including C-reactive protein in cardiovascular risk prediction models for women. Ann Intern Med 2006; 145(1): 21-9.
29.  Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar A-A, Hekmatdoost A, et al. Prospective epidemiological research studies in Iran (the PERSIAN Cohort Study): rationale, objectives, and design. Am J Epidemiol 2018; 187(4): 647-55.
30.  ASCVD Risk Estimator + 2023 [Available from: https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/.
31.  Pesce G, Gusto G, Johansen P, Khachatryan A, Lopez-Ledesma B, Vukmirica J, et al. Systemic inflammation prevalence in patients with atherosclerotic cardiovascular disease and chronic kidney disease: a population-based study using a nationwide primary care database in Spain. Front Cardiovasc Med 2025; 12: 1538466.
32.  Ridker PM, Cook N. Clinical usefulness of very high and very low levels of C-reactive protein across the full range of Framingham Risk Scores. Circulation 2004; 109(16): 1955-9.
33.  Cederström S, Lundman P, Alfredsson J, Hagström E, Ravn-Fischer A, Söderberg S, et al. Association between high-sensitivity C-reactive protein and coronary atherosclerosis in a general middle-aged population. Sci Rep 2023; 13(1): 12171.
34.  Grufman H, Gonçalves I, Edsfeldt A, Nitulescu M, Persson A, Nilsson M, et al. Plasma levels of high-sensitive C-reactive protein do not correlate with inflammatory activity in carotid atherosclerotic plaques. J Intern Med 2014; 275(2): 127-33.
35.  Swastini DA, Wiryanthini IAD, Ariastuti NLP, Muliantara A. Atherosclerosis Prediction with High Sensitivity C-Reactive Protein (hs-CRP) and Related Risk Factor in Patient with Dyslipidemia. Open Access Maced J Med Sci 2019; 7(22): 3887-90.
36.  Kones R. The Jupiter study, CRP screening, and aggressive statin therapy-implications for the primary prevention of cardiovascular disease. Ther Adv Cardiovasc Dis 2009; 3(4): 309-15.
37.  Singh SK, Agrawal A. Functionality of C-reactive protein for atheroprotection. Front Immunol 2019; 10: 1655.
Journal of Isfahan Medical School
Volume 44, Issue 870
2nd Week, September
September and October 2026
Pages 1240-1247

  • Receive Date 16 August 2025
  • Revise Date 19 July 2026
  • Accept Date 25 July 2026