title: High-sensitivity C-reactive protein in high-grade carotid stenosis: risk marker for unstable carotid plaque.
abstract: OBJECTIVE
  Increasing evidence points to the inflammatory character of atherosclerosis, and several parameters of inflammation have been proposed as cardiovascular risk markers. We analyzed associations among serum high-sensitivity C-reactive protein (hs-CRP) concentrations, carotid plaque structure, and immunocytology, and neurologic symptoms in patients with high-grade carotid stenosis.
  
  
  METHODS
  This was a cross-sectional study in a referral center and institutional practice in hospitalized patients. The study included 62 patients with greater than 70% carotid stenosis treated surgically; 58% of patients had symptoms, and 42% did not. Serum hs-CRP concentrations were determined 48 hours before surgery; levels greater than 10 mg/L were considered pathologic. Histopathologic analysis (stable or unstable) and immunohistochemistry (macrophage count, T lymphocytes, activated T lymphocytes) were carried out on the atherosclerotic plaques.
  
  
  RESULTS
  Median hs-CRP values were 7.6 mg/L (range, 0-165 mg/L). Median hs-CRP concentrations were higher in patients with unstable plaque (53.2%) than in patients with stable plaque (46.7%): 27.1 mg/L (range, 1.8-165 mg/L) versus 4.1 mg/L (range, 0.3-56 mg/L) (P <.001). Among patients with symptomatic disease, 81% had CRP concentrations significantly higher than CRP concentrations in patients with asymptomatic disease (P <.001). A statistically significant association was found between hs-CRP levels and the presence of macrophages (Spearman rank correlation [rho], 0.61, P <.001) and T lymphocytes in the plaque (Spearman rank correlation [rho], 0.52, P <.001). At logistic regression analysis, neurologic event and macrophages in the plaque were independently associated with unstable plaque.
  
  
  CONCLUSIONS
  Increased hs-CRP levels may be related to the presence of macrophages and T lymphocytes in plaque, which is associated with the phenomena of instability that can lead to development of an ischemic event. Thus determination of circulating hs-CRP levels may be a useful additional marker of risk in patients with high-grade carotid stenosis.
authors: Department of Vascular and Endovascular Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 30908bag@comb.es
authors: Beatriz
authors: B
authors: Alvarez Garcia
authors: Carmen
authors: C
authors: Ruiz
authors: Pilar
authors: P
authors: Chacon
authors: Jose Alvarez
authors: JA
authors: Sabin
authors: Manuel
authors: M
authors: Matas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000209:etiology / Q000276:immunology*; D002097:C-Reactive Protein / Q000032:analysis* / Q000276:immunology; D016893:Carotid Stenosis / Q000097:blood / Q000150:complications / Q000276:immunology* / Q000601:surgery; D003430:Cross-Sectional Studies; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein