title: The impacts of C-reactive protein and atrial fibrillation on carotid atherosclerosis and ischemic stroke in patients with suspected ischemic cerebrovascular disease: a single-center retrospective observational cohort study.
abstract: OBJECTIVE
  Carotid intima-media thickness (IMT) is associated with chronic inflammation, and C-reactive protein (CRP) level is elevated in patients with atrial fibrillation (AF). We investigated the impacts of CRP and AF on carotid atherosclerosis and ischemic stroke in patients with suspected ischemic cerebrovascular disease.
  
  
  METHODS
  One-hundred forty patients (78 males) with suspected ischemic cerebrovascular disease underwent carotid ultrasonography. The mean common carotid artery IMT, mean internal carotid artery (ICA) IMT, and plaque score were measured. Patients were divided into four groups according to the presence of AF and elevated CRP level {n=46 for AF(-)CRP(-), n=38 for AF(-)CRP(+), n=43 for AF(+)CRP(-), and n=13 for AF(+)CRP(+)}.
  
  
  RESULTS
  Common carotid artery IMT was significantly higher in the AF(-)CRP(+) (0.98±0.51 mm) and AF(+)CRP(+) (0.96±0.27 mm) groups compared to the AF(-)CRP(-) (0.80±0.32 mm) and AF(+)CRP(-) (0.77±0.19 mm) groups (p=0.027). Although there was no significant difference in mean ICA IMT among the groups, plaque score was the highest in the AF(+)CRP(+) (4.18±3.84 mm) group, followed by AF(-)CRP(+) (3.87±2.78 mm), AF(+)CRP(-) (1.34±2.61 mm), and AF(-)CRP(-) (1.17±2.02 mm) (p<0.001). The AF(+)CRP(+) group showed significantly higher incidence of ischemic stroke than the other groups (all p<0.05). Binary logistic regression analysis showed that age {odds ratio (OR)=1.033, p=0.001}, elevated CRP (OR=3.884, p=0.001), and the presence of AF (OR=1.375, p=0.018) were significantly correlated with incidence of ischemic stroke.
  
  
  CONCLUSIONS
  Elevated plasma CRP concentration may be a reliable surrogate marker for predicting carotid atherosclerosis in patients with AF, which may be related to increased risk of ischemic stroke.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Ock
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: Kyoung Im
authors.initials: KI
authors.lastname: Cho
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: Nae Young
authors.initials: NY
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: Weon Hyoung
authors.initials: WH
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: Go Eun
authors.initials: GE
authors.lastname: Yeo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: Jae Joon
authors.initials: JJ
authors.lastname: Heo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: You Jin
authors.initials: YJ
authors.lastname: Han
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University College of Medicine, Busan, Korea.
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Cha
keywords: Atrial fibrillation; C-reactive protein; Carotid atherosclerosis