title: Association between obesity, high-sensitivity C-reactive protein ≥2 mg/L, and subclinical atherosclerosis: implications of JUPITER from the Multi-Ethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  High-sensitivity C-reactive protein (hsCRP) levels are closely associated with abdominal obesity, metabolic syndrome, and atherosclerotic cardiovascular disease. The Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial has encouraged using hsCRP ≥2 mg/L to guide statin therapy; however, the association of hsCRP and atherosclerosis, independent of obesity, remains unknown.
  
  
  RESULTS
  We studied 6760 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). Participants were stratified into 4 groups: nonobese/low hsCRP, nonobese/high hsCRP, obese/low hsCRP, and obese/high hsCRP. Using multivariable logistic and robust linear regression, we described the association with subclinical atherosclerosis, using coronary artery calcium (CAC) and carotid intima-media thickness (cIMT). Mean body mass index was 28.3±5.5 kg/m(2), and median hsCRP was 1.9 mg/L (0.84 to 4.26). High hsCRP, in the absence of obesity, was not associated with CAC and was mildly associated with cIMT. Obesity was strongly associated with CAC and cIMT independently of hsCRP. When obesity and high hsCRP were both present, there was no evidence of multiplicative interaction. Similar associations were seen among 2083 JUPITER-eligible individuals.
  
  
  CONCLUSIONS
  High hsCRP, as defined by JUPITER, was not associated with CAC and was mildly associated with cIMT in the absence of obesity. In contrast, obesity was associated with both measures of subclinical atherosclerosis independently of hsCRP status.
authors.affiliation: Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA. mblaha1@jhmi.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Rivera
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Arthur
authors.initials: A
authors.lastname: Agatston
authors.forename: Daniel H
authors.initials: DH
authors.lastname: O'Leary
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: Susan
authors.initials: S
authors.lastname: Lakoski
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D002118:Calcium / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D002339:Carotid Arteries / Q000473:pathology; D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000150:complications; D011743:Pyrimidines / Q000627:therapeutic use*; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000627:therapeutic use*; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D055105:Waist Circumference
chemical_list: D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D002097:C-Reactive Protein; D002118:Calcium