Studies Explore Links Between C-reactive Protein, Metabolic Syndrome, and Cardiovascular Disease

NEW ORLEANS—Measuring levels of C-reactive protein (CRP) may help to further stratify cardiovascular (CV) risk in patients with metabolic syndrome or diabetes mellitus, possibly identifying high-risk subsets that warrant aggressive intervention, said Shaista Malik, MD, MPH, at the 53rd Annual Scientific Session of the American College of Cardiology.

In a cross-sectional analysis of 6497 adults who participated in the Third National Health and Nutrition Examination Survey, she found that the likelihood of developing CV disease (CVD) increases with each additional risk factor for metabolic syndrome and is greatest in those populations that also have high levels of CRP.

The presence of 2 risk factors for metabolic syndrome more than quadrupled the risk of CVD compared with no risk factors.

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A correspondingly higher risk of CVD was observed in those with higher CRP compared with patients without metabolic syndrome or diabetes and a low CRP level (=3 mg/L). Patients with metabolic syndrome and high CRP (>3 mg/L) had an odds ratio of CVD of 2.35 ( <.0001). The highest risk group was patients with diabetes and high CRP levels, who had a nearly 6-fold increased risk ( <.0001) compared with patients without diabetes or metabolic syndrome and a low CRP level.

"This study supports previous research showing that CRP is an important marker for stratifying risk for CVD,"said Dr Malik, a cardiology fellow at the University of California, Irvine.

In a new analysis of the Framingham Offspring Study, CRP was found to be related to all components of metabolic syndrome, and this relationship was stronger in women than in men, said Martin K. Rutter, MD, professor, department of medicine, University of Manchester, United Kingdom. His analysis consisted of 3037 subjects who were followed for more than 8 years. Out of this group, 24% had metabolic syndrome.

A multivariate model was performed using CRP levels and the 5 features of metabolic syndrome— central adiposity, hypertriglyceridemia, a low level of highdensity lipoprotein cholesterol, hypertension, and fasting blood glucose levels of =110 mg/dL. The CRP level increased with each component of metabolic syndrome: those with no traits of metabolic syndrome had a mean CRP level of 0.3 mg/L; those with 4 or 5 traits had a mean CRP level of 4.1 mg/L.

Furthermore, participants with the greatest number of metabolic syndrome characteristics were 1.8 times as likely to have a CVD event compared with subjects with the fewest number of metabolic syndrome characteristics. Similarly, in participants with the highest CRP levels, the risk of CVD was almost twice as high as those with the lowest CRP levels.

Higher CRP levels in women compared with men with metabolic syndrome may help to explain the greater increase in CVD risk in women with metabolic syndrome or diabetes, said Dr Rutter.

CRP and metabolic syndrome were both independent risk factors for CVD in this study. "Future research should establish if CVD risk prediction for individual patients is improved using both variables compared with using either variable independently," he said.

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