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Association between C-reactive protein level and peripheral arterial disease among US adults without cardiovascular disease, diabetes, or hypertension.
Am Heart J. 2007 Sep; 154(3):495-501.AH

Abstract

BACKGROUND

Inflammatory processes are implicated in the development and progression of atherosclerotic cardiovascular disease (CVD). C-reactive protein (CRP), a specific marker of inflammation, has been found to be related to CVD and subclinical atherosclerosis, including peripheral arterial disease (PAD). However, it is not entirely clear whether CRP levels are related to subclinical CVD independent of traditional risk factors, including diabetes and hypertension. We examined the association between CRP levels and PAD among US adults free of CVD, diabetes, and hypertension.

METHODS

Cross-sectional study was performed among 1611 National Health and Nutrition Examination Survey 1999-2002 participants aged > or = 40 years and without CVD, diabetes, or hypertension. Main outcome of interest was PAD defined as ankle-brachial index < 0.9.

RESULTS

Higher CRP levels were positively associated with PAD, independent of smoking, waist circumference, body mass index, blood pressure, glycosylated hemoglobin, serum total cholesterol, and other confounders. Multivariable odds ratio (95% CI) comparing quartile 4 of CRP (> 0.54 mg/dL) to quartile 1 (< 0.09 mg/dL) was 6.38 (1.77-22.96); P trend = .005. This association persisted in separate analysis in men and women. Furthermore, the results were consistent in subgroup analyses by categories of age, education, smoking, and body mass index. In nonparametric models, the positive association between CRP and PAD seemed to be present across the full range of CRP without any apparent threshold.

CONCLUSIONS

Higher CRP levels are associated with PAD among US adults free of CVD, diabetes, and hypertension. These results suggest that inflammatory mechanisms related to atherosclerosis may be operative even among clinically healthy adults.

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Authors+Show Affiliations

Shankar A
Department of Community, Occupational, and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. ashankar@nus.edu.sg
Li J
No affiliation info available
Nieto FJ
No affiliation info available
Klein BE
No affiliation info available
Klein R
No affiliation info available

MeSH

C-Reactive ProteinCardiovascular DiseasesCross-Sectional StudiesDiabetic AngiopathiesFemaleHumansHypertensionMaleMiddle AgedPeripheral Vascular DiseasesUnited States

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17719297

Citation

Shankar, Anoop, et al. "Association Between C-reactive Protein Level and Peripheral Arterial Disease Among US Adults Without Cardiovascular Disease, Diabetes, or Hypertension." American Heart Journal, vol. 154, no. 3, 2007, pp. 495-501.
Shankar A, Li J, Nieto FJ, et al. Association between C-reactive protein level and peripheral arterial disease among US adults without cardiovascular disease, diabetes, or hypertension. Am Heart J. 2007;154(3):495-501.
Shankar, A., Li, J., Nieto, F. J., Klein, B. E., & Klein, R. (2007). Association between C-reactive protein level and peripheral arterial disease among US adults without cardiovascular disease, diabetes, or hypertension. American Heart Journal, 154(3), 495-501.
Shankar A, et al. Association Between C-reactive Protein Level and Peripheral Arterial Disease Among US Adults Without Cardiovascular Disease, Diabetes, or Hypertension. Am Heart J. 2007;154(3):495-501. PubMed PMID: 17719297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between C-reactive protein level and peripheral arterial disease among US adults without cardiovascular disease, diabetes, or hypertension. AU - Shankar,Anoop, AU - Li,Jialiang, AU - Nieto,F Javier, AU - Klein,Barbara E K, AU - Klein,Ronald, PY - 2006/12/05/received PY - 2007/04/29/accepted PY - 2007/8/28/pubmed PY - 2007/9/6/medline PY - 2007/8/28/entrez SP - 495 EP - 501 JF - American heart journal JO - Am Heart J VL - 154 IS - 3 N2 - BACKGROUND: Inflammatory processes are implicated in the development and progression of atherosclerotic cardiovascular disease (CVD). C-reactive protein (CRP), a specific marker of inflammation, has been found to be related to CVD and subclinical atherosclerosis, including peripheral arterial disease (PAD). However, it is not entirely clear whether CRP levels are related to subclinical CVD independent of traditional risk factors, including diabetes and hypertension. We examined the association between CRP levels and PAD among US adults free of CVD, diabetes, and hypertension. METHODS: Cross-sectional study was performed among 1611 National Health and Nutrition Examination Survey 1999-2002 participants aged > or = 40 years and without CVD, diabetes, or hypertension. Main outcome of interest was PAD defined as ankle-brachial index < 0.9. RESULTS: Higher CRP levels were positively associated with PAD, independent of smoking, waist circumference, body mass index, blood pressure, glycosylated hemoglobin, serum total cholesterol, and other confounders. Multivariable odds ratio (95% CI) comparing quartile 4 of CRP (> 0.54 mg/dL) to quartile 1 (< 0.09 mg/dL) was 6.38 (1.77-22.96); P trend = .005. This association persisted in separate analysis in men and women. Furthermore, the results were consistent in subgroup analyses by categories of age, education, smoking, and body mass index. In nonparametric models, the positive association between CRP and PAD seemed to be present across the full range of CRP without any apparent threshold. CONCLUSIONS: Higher CRP levels are associated with PAD among US adults free of CVD, diabetes, and hypertension. These results suggest that inflammatory mechanisms related to atherosclerosis may be operative even among clinically healthy adults. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/17719297/Association_between_C_reactive_protein_level_and_peripheral_arterial_disease_among_US_adults_without_cardiovascular_disease_diabetes_or_hypertension_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00415-2 DB - PRIME DP - Unbound Medicine ER -