Combined Effects of Inflammatory Status and Carotid Atherosclerosis: A 12-Year Follow-Up Study.
Inflammatory responses play a key role in atherogenesis. The aim of this study was to assess the prognostic value of hsCRP (high-sensitivity C-reactive protein) and to evaluate whether degree of carotid stenosis and serum levels of hsCRP jointly predict long-term mortality in asymptomatic patients with carotid atherosclerosis.



One thousand sixty-five patients with neurological asymptomatic carotid atherosclerosis as evaluated by duplex sonography were prospectively followed for cause-specific mortality.



During a median of 11.81 years, a total of 549 deaths, including 362 cardiovascular deaths, were recorded. The risk of all-cause and cardiovascular mortality significantly increased in patients with elevated serum levels of hsCRP (the adjusted hazard ratio for cardiovascular mortality per increase of 1 mg/dL of hsCRP levels was 1.47; P<0.001). Patients with a high degree of carotid stenosis and increased hsCRP levels were particularly at risk of adverse outcome. Patients with carotid narrowing over 50% and hsCRP levels >0.29 mg/dL (=median) had nearly twice as high a risk of cardiovascular mortality compared with patients with carotid stenosis of <50% and hsCRP levels <0.29 mg/dL (adjusted hazard ratio 1.89; P<0.001). Improvement in risk stratification with combined assessment of carotid stenosis and hsCRP was confirmed by an improvement of the continuous net reclassification improvement with 18% for all-cause mortality and 15% for cardiovascular mortality compared with the degree of carotid stenosis alone (P<0.01).



Measurement of hsCRP in combination with ultrasound investigations of the carotid arteries at a single time point provides additional prognostic information for patients with asymptomatic carotid atherosclerosis.
From the Department of Laboratory Medicine (F.J.M., C.J.B., O.F.W., D.T.), Division of Angiology, Department of Internal Medicine II (M.S., E.M., W.M., M.H.), and Division of Cardiology, Department of Internal Medicine II (G.G.), Medical University of Vienna, Austria. florian.mayer@meduniwien.ac.at.
Florian J
FJ
Mayer
From the Department of Laboratory Medicine (F.J.M., C.J.B., O.F.W., D.T.), Division of Angiology, Department of Internal Medicine II (M.S., E.M., W.M., M.H.), and Division of Cardiology, Department of Internal Medicine II (G.G.), Medical University of Vienna, Austria.
Christoph J
CJ
Binder
From the Department of Laboratory Medicine (F.J.M., C.J.B., O.F.W., D.T.), Division of Angiology, Department of Internal Medicine II (M.S., E.M., W.M., M.H.), and Division of Cardiology, Department of Internal Medicine II (G.G.), Medical University of Vienna, Austria.
Oswald F
OF
Wagner
From the Department of Laboratory Medicine (F.J.M., C.J.B., O.F.W., D.T.), Division of Angiology, Department of Internal Medicine II (M.S., E.M., W.M., M.H.), and Division of Cardiology, Department of Internal Medicine II (G.G.), Medical University of Vienna, Austria.
Martin
M
Schillinger
From the Department of Laboratory Medicine (F.J.M., C.J.B., O.F.W., D.T.), Division of Angiology, Department of Internal Medicine II (M.S., E.M., W.M., M.H.), and Division of Cardiology, Department of Internal Medicine II (G.G.), Medical University of Vienna, Austria.
Erich
E
Minar
From the Department of Laboratory Medicine (F.J.M., C.J.B., O.F.W., D.T.), Division of Angiology, Department of Internal Medicine II (M.S., E.M., W.M., M.H.), and Division of Cardiology, Department of Internal Medicine II (G.G.), Medical University of Vienna, Austria.
Wolfgang
W
Mlekusch
From the Department of Laboratory Medicine (F.J.M., C.J.B., O.F.W., D.T.), Division of Angiology, Department of Internal Medicine II (M.S., E.M., W.M., M.H.), and Division of Cardiology, Department of Internal Medicine II (G.G.), Medical University of Vienna, Austria.
Dimitris
D
Tsiantoulas
From the Department of Laboratory Medicine (F.J.M., C.J.B., O.F.W., D.T.), Division of Angiology, Department of Internal Medicine II (M.S., E.M., W.M., M.H.), and Division of Cardiology, Department of Internal Medicine II (G.G.), Medical University of Vienna, Austria.
Georg
G
Goliasch
From the Department of Laboratory Medicine (F.J.M., C.J.B., O.F.W., D.T.), Division of Angiology, Department of Internal Medicine II (M.S., E.M., W.M., M.H.), and Division of Cardiology, Department of Internal Medicine II (G.G.), Medical University of Vienna, Austria.
Matthias
M
Hoke
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D002340:Carotid Artery Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality*; D016893:Carotid Stenosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged
D002097:C-Reactive Protein
C-reactive protein; biomarker; carotid atherosclerosis; carotid stenosis; risk factor