Correlation of C-Reactive Protein (CRP) in Blood and the Atherosclerotic Plaque and its Severity in Patients with Diabetes Mellitus Undergoing Coronary Artery Bypass Graft Surgery

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Physiology, School of Medicine AND Physiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Young Researchers and Elites club, Science and Research Branch, Islamic Azad University, Tehran, Iran

5 Department of Nursing, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Atherosclerosis is a chronic inflammatory disease. There are several inflammatory molecules involved in the development of atherosclerosis. Among them, C-reactive Protein (CRP) is the best known biomarker for disease progression, plaque instability and fragility. This study aimed to determine the correlation of the venous CRP with plaque CRP in patients undergoing elective coronary artery bypass graft (CABG) surgery.Methods: This study was done on 22 men with diabetes mellitus candidate for CABG surgery. Blood samples were taken from patients before surgery to determine the venous blood CRP level. The atherosclerotic plaque was removed from the vessel wall during the surgery. Samples of coronary atherosclerotic plaques were stained with Hematoxilin and Eosin to measure intima and media thickness and calculate the intima to media ratio (IMR). The immunohistochemistry staining was used to determine the CRP expression levels. Venous blood hsCRP concentrations were determined by ELISA method.Findings: There was no significant correlation between the intensity of CRP expression in atherosclerosis plaques and hsCRP concentrations in venous blood; but there was a significant correlation between the venous blood hsCRP concentration and severity of atherosclerosis (the IMR).Conclusion: Increased CRP represents systemic inflammation in the body and is correlated with the severity of atherosclerosis; so, it can be a reliable biomarker of disease progression. Despite of the existence of CRP in the atherosclerotic plaque, there is no correlation between the expression of CRP and hsCRP concentrations.

Keywords

References

  1. Blaha MJ, Nasir Kh, Blumenthal RS. Statin therapy for healthy men identified as "increased risk". JAMA 2012; 307(14): 1489-90.
  2. Gossl M, Versari D, Hildebrandt H, Mannheim D, Olson ML, Lerman LO, et al. Vulnerable plaque: detection and management. Med Clin North Am 2007; 91(4): 573-601.
  3. Hansson GK, Libby P. The immune response in atherosclerosis: a double-edged sword. Nat Rev Immunol 2006; 6(7): 508-19.
  4. Black S, Kushner I, Samols D. C-reactive Protein. J Biol Chem 2004; 279(47): 48487-90.
  5. Agrawal A. CRP after 2004. Mol Immunol 2005; 42(8): 927-30.
  6. Yeh ET. CRP as a mediator of disease. Circulation 2004; 109(21 Suppl 1): II11-II14.
  7. Ridker PM, Silvertown JD. Inflammation, C-reactive protein, and atherothrombosis. J Periodontol 2008; 79(8 Suppl): 1544-51.
  8. Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998; 279(18): 1477-82.
  9. 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.
  10. Farb A, Burke AP, Tang AL, Liang TY, Mannan P, Smialek J, et al. Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation 1996; 93(7): 1354-63.
  11. Davies MJ. Going from immutable to mutable atherosclerotic plaques. Am J Cardiol 2001; 88(4A): 2F-9F.
  12. Oliver MF, Davies MJ. The atheromatous lipid core. Eur Heart J 1998; 19(1): 16-8.
  13. Libby P, Ridker PM. Inflammation and atherosclerosis: role of C-reactive protein in risk assessment. Am J Med 2004; (116 Suppl 6A): 9S-16S.
  14. Ridker PM, Cannon CP, Morrow D, Rifai N, Rose LM, McCabe CH, et al. C-reactive protein levels and outcomes after statin therapy. N Engl J Med 2005; 352(1): 20-8.
  15. Krupinski J, Turu MM, Martinez-Gonzalez J, Carvajal A, Juan-Babot JO, Iborra E, et al. Endogenous expression of C-reactive protein is increased in active (ulcerated noncomplicated) human carotid artery plaques. Stroke 2006; 37(5): 1200-4.
  16. Kobayashi S, Inoue N, Ohashi Y, Terashima M, Matsui K, Mori T, et al. Interaction of oxidative stress and inflammatory response in coronary plaque instability: important role of C-reactive protein. Arterioscler Thromb Vasc Biol 2003; 23(8): 1398-404.
  17. Sun H, Koike T, Ichikawa T, Hatakeyama K, Shiomi M, Zhang B, et al. C-reactive protein in atherosclerotic lesions: its origin and pathophysiological significance. Am J Pathol 2005; 167(4): 1139-48.
  18. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340(2): 115-26.
  19. Haider DG, Leuchten N, Schaller G, Gouya G, Kolodjaschna J, Schmetterer L, et al. C-reactive protein is expressed and secreted by peripheral blood mononuclear cells. Clin Exp Immunol 2006; 146(3): 533-9.
  20. Yasojima K, Schwab C, McGeer EG, McGeer PL. Generation of C-reactive protein and complement components in atherosclerotic plaques. Am J Pathol 2001; 158(3): 1039-51.
  21. Calabro P, Willerson JT, Yeh ET. Inflammatory cytokines stimulated C-reactive protein production by human coronary artery smooth muscle cells. Circulation 2003; 108(16): 1930-2.
  22. Mugabo Y, Li L, Renier G. The connection between C-reactive protein (CRP) and diabetic vasculopathy. Focus on preclinical findings. Curr Diabetes Rev 2010; 6(1): 27-34.
  23. Andrie RP, Bauriedel G, Braun P, Hopp HW, Nickenig G, Skowasch D. Increased expression of C-reactive protein and tissue factor in acute coronary syndrome lesions: Correlation with serum C-reactive protein, angioscopic findings, and modification by statins. Atherosclerosis 2009; 202(1): 135-43.
  24. Sigurdardottir V, Fagerberg B, Hulthe J. Preclinical atherosclerosis and inflammation in 61-year-old men with newly diagnosed diabetes and established diabetes. Diabetes Care 2004; 27(4): 880-4.
  25. Ahmad J, Ahmned F, Siddiqui MA, Khan AR, Katyal P, Hameed B, et al. Inflammatory markers, insulin resistance and carotid intima-media thickness in North-Indian type 2 diabetic subjects. J Assoc Physicians India 2007; 55: 693-9.
  26. Tanaka A, Shimada K, Sano T, Namba M, Sakamoto T, Nishida Y, et al. Multiple plaque rupture and C-reactive protein in acute myocardial infarction. J Am Coll Cardiol 2005; 45(10): 1594-9.
  27. Hong YJ, Mintz GS, Kim SW, Okabe T, Bui AB, Pichard AD, et al. Impact of plaque rupture and elevated C-reactive protein on clinical outcome in patients with acute myocardial infarction: an intravascular ultrasound study. J Invasive Cardiol 2008; 20(9): 428-35.
Journal of Isfahan Medical School
Volume 31, Issue 228 - Serial Number 228
January and February 2013
Pages 247-254

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History

  • Receive Date: 09 November 2012
  • Revise Date:
  • Accept Date: 06 April 2022

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