High-sensitivity C-reactive protein is only weakly related to cardiovascular damage after adjustment for traditional cardiovascular risk factors

Background: The independent prognostic value of high-sensitivity C-reactive protein (hsCRP) has been questioned, and consequently we decided to investigate whether hsCRP was associated with subclinical cardiovascular (CV) damage independently of traditional CV risk factors. Methods: In a population-based sample of 2028 apparently healthy individuals without prior stroke or myocardial infarction not receiving any CV, anti-diabetic or lipid-lowering treatment, aged 41, 51, 61 or 71 years, we measured in 1993 serum hsCRP, traditional CV risk factors (lifestyle, metabolic and hemodynamic) and assessed subclinical CV damage [atherosclerotic plaques in the carotid arteries, pulse wave velocity (PWV), urine albumin/creatinine ratio (UACR), left ventricular (LV) mass and ejection fraction]. Results: Adjusting for age and gender in multiple regression analyses, higher log(hsCRP) was associated with higher logPWV (β = 0.15) and log(left ventricular mass index) (LVMI) (β = 0.09, both P < 0.001), LV relative wall thickness (β = 0.07, P < 0.01), logUACR (β = 0.04, P = 0.06) and more atherosclerotic plaques (β = 0.06, P < 0.05). However, higher log(hsCRP) was only weakly associated with higher logPWV(β = 0.06, P < 0.05) and more atherosclerotic plaques (β = 0.04, P = 0.06) when adjusting for other significant CV risk factors, such as daily smoking (β = 0.18), female gender (β = -0.17), older age (β = 0.11), lower log(high density lipoprotein cholesterol) (β = -0.11, all P < 0.001); wider waist (β = 0.17), higher body mass index (β = 0.14), higher heart rate (β = 0.06, all P < 0.01); and higher logiplasma glucose) (β = 0.05, P < 0.05) (adj. R ² = 0.19, P < 0.001). Conclusion: After adjustment for traditional CV risk factors hsCRP was only associated with PWV and atherosclerotic plaques, indicating a possible effect of low-grade inflammation on macrovascular damage. The close relationship between traditional CV risk factors and hsCRP suggested that hsCRP was an integrated CV risk marker early in the development of atherosclerosis.