C-reactive Protein Is Independently Associated With Coronary Atherosclerosis Burden Among Octogenarians

Aim of the study: In contrast to the general population, individuals with primarily persistent elevation of inflammatory activity display a significant association between inflammatory biomarkers and atherosclerotic burden. In older individuals, immunosenescence upregulates the innate response and, by this way, may hypothetically favor the presence of this association. The aim of this study was to evaluate this hypothesis in healthy octogenarians. Methods: Participants (n = 208) aged 80 years or older, asymptomatic and without medical and laboratory evidence of chronic diseases or use of anti-inflammatory treatments were included in the study. Lipid profile and plasma C-reactive protein (CRP) were measured at baseline and cardiac computed tomography was performed within 1-week interval for measuring coronary calcium score (CCS). Results: The median plasma CRP was 1.9 mg/L (1.0-3.4) and 33% of the participants had elevated CRP defined as ≥3 mg/L. Among those with high CRP, there was an increased frequency of high CCS (≥100) as compared with their counterparts (71 vs 50%, p = 0.001). The association between CRP and CCS persisted even after adjustment for age, sex, cardiovascular risk factors and statin therapy. The area under the receiver-operating curve for CRP was 0.606 using CCS ≥100 as a binary outcome. The sensitivities for CCS ≥100 were 40 and 74% for the cutoff points of CRP ≥3 or 1 mg/L, respectively. Conclusion: The present study was able to confirm that in very elderly individuals, systemic inflammatory activity is independently associated with coronary atherosclerosis burden. © Springer International Publishing 2013.2611923Morrow, D.A., Rifai, N., Antman, E.M., Weiner, D.L., McCabe, C.H., Cannon, C.P., Braunwald, E., C-reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes: A TIMI 11A substudy (1998) Journal of the American College of Cardiology, 31 (7), pp. 1460-1465. , DOI 10.1016/S0735-1097(98)00136-3, PII S0735109798001363Sposito, A.C., Alvarenga, B.F., Alexandre, A.S., Araujo, A.L., Santos, S.N., Andrade, J.M., Ramires, J.A., Coelho, O.R., Most of the patients presenting myocardial infarction would not be eligible for intensive lipid-lowering based on clinical algorithms or plasma C-reactive protein (2011) Atherosclerosis, 214 (1), pp. 148-150. , doi:10.1016/j.atherosclerosis.2010.10.034Gupta, N.K., De Lemos, J.A., Ayers, C.R., Abdullah, S.M., McGuire, D.K., Khera, A., The relationship between C-reactive protein and atherosclerosis differs on the basis of body mass index: The Dallas Heart Study (2012) J Am Coll Cardiol, 60 (13), pp. 1148-1155. , doi:10.1016/j.jacc.2012.04.050Hamirani, Y.S., Pandey, S., Rivera, J.J., Ndumele, C., Budoff, M.J., Blumenthal, R.S., Nasir, K., Markers of inflammation and coronary artery calcification: A systematic review (2008) Atherosclerosis, 201 (1), pp. 1-7. , doi:10.1016/j.atherosclerosis.2008.04.045Yiu, K.H., Wang, S., Mok, M.Y., Ooi, G.C., Khong, P.L., Mak, K.F., Lam, K.F., Tse, H.F., Pattern of arterial calcification in patients with systemic lupus erythematosus (2009) J Rheumatol, 36 (10), pp. 2212-2217. , doi:10.3899/jrheum.090312Wolf, J., Weinberger, B., Arnold, C.R., Maier, A.B., Westendorp, R.G., Grubeck-Loebenstein, B., The effect of chronological age on the inflammatory response of human fibroblasts (2012) Exp Gerontol, 47 (9), pp. 749-753. , doi:10.1016/j.exger.2012.07.001Freitas, W.M., Quaglia, L.A., Santos, S.N., Soares, A.A., Japiassu, A.V., Boaventura, V., Dos Santos Barros, E., Sposito, A.C., Association of systemic inflammatory activity with coronary and carotid atherosclerosis in the very elderly (2011) Atherosclerosis, 216 (1), pp. 212-216. , doi:10.1016/j.atherosclerosis.2011.01.040Smith, R.A., Cokkinides, V., Eyre, H.J., American cancer society guidelines for the early detection of cancer (2006) CA Cancer J Clin, 56 (1), pp. 11-25. , 2006 quiz 49-50(2007) A Guide for Population-based Approaches to Increasing Levels of Physical Activity: Implementation of the WHO Global Strategy on Diet, Physical Activity and Health, , World Health OrganizationSchuett, H., Luchtefeld, M., Grothusen, C., Grote, K., Schieffer, B., How much is too much? Interleukin-6 and its signalling in atherosclerosis (2009) Thromb Haemost, 102 (2), pp. 215-222. , doi:10.1160/TH09-05-0297Tintut, Y., Patel, J., Parhami, F., Demer, L.L., Tumor necrosis factor-alpha promotes in vitro calcification of vascular cells via the cAMP pathway (2000) Circulation, 102 (21), pp. 2636-2642DeGoma, E.M., French, B., Dunbar, R.L., Allison, M.A., Mohler III, E.R., Budoff, M.J., Intraindividual variability of C-reactive protein: The multi-ethnic study of atherosclerosis (2012) Atherosclerosis, 224 (1), pp. 274-279. , doi:10.1016/j.atherosclerosis.2012.07.017Demer, L.L., Tintut, Y., Vascular calcification: Pathobiology of a multifaceted disease (2008) Circulation, 117 (22), pp. 2938-2948. , DOI 10.1161/CIRCULATIONAHA.107.743161, PII 000030172008060300001