Evaluation of Lasting High Levels of CRP among the Patients with Metabolic Syndrome
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Evaluation of Lasting High Levels of CRP among the Patients with Metabolic Syndrome Osamu Saiki,1,4 Makihiko Kuhara,2 Nozomi Kikuchi,1 Sanshirou Shiraishi,1 and Hiroshi Uda3
Abstract—“Low-grade” systemic inflammation is common findings in patients with metabolic syndrome (MetS). When we assessed 256 MetS patients, we found eight patients who presented high levels of C-reactive protein (CRP) which are between 40 and 15 mg/L for more than 3 years. They have not satisfied any criteria of inflammatory diseases such as rheumatoid arthritis and the area of visceral fat estimated by computed tomography was more than 200 cm2. All the other MetS patients of visceral fat over 200 cm2 presented low levels of CRP which are less than 10 mg/L. Insulin resistance and ultrasound study of carotid plaques showed no differences between high and low levels of CRP patients. There are a series of MetS patients who show high levels of CRP without clinical symptoms of inflammatory diseases. High levels of CRP merely cannot be explained by visceral fat area, insulin resistance, or carotid plaques. KEY WORDS: C-reactive protein; metabolic syndrome; inflammation.
and contribute to both the waxing and the waning of inflammation at different points in its evolution. MetS and its components have been consistently associated with the presence of “low-grade” systemic inflammation [6, 7]. Inflammation is recognized as one of the central features of atherosclerosis and plays a key role in plaque rapture and therefore in most episodes of acute coronary events [8]. The acute phase reactant, C-reactive protein (CRP) is an extremely sensitive marker of systemic inflammation and the elevation of CRP are observed in most of inflammatory diseases such as rheumatoid arthritis, pneumonia, and collagen diseases. Elevated concentrations of CRP, although still in the normal range, not only are independent predictors of future CHD [3, 9], but have been also associated with different features of MetS [5]. The specific pathways linking elevated CRP levels to MetS have not been definitively clarified. Different but not mutually exclusive mechanisms have been proposed including chronicover-nutrition [10], presence of subclinical atherosclerosis or cardiovascular disease related to MetS [11, 12], a direct effect of insulin resistance [13], and body fat accumulation or obesity [14, 15]. Schrager et al. recently suggested a direct effect of waist circumference on systemic inflammation [16].
INTRODUCTION Metabolic syndrome (MetS) is a very common clinical condition characterized by the clustering of cardiovascular risk factors related to insulin resistance, including central obesity, impaired glucose tolerance, hypertension, and dyslipidemia [1, 2]. MetS is a risk factor for type 2 diabetes and coronary heart disease (CHD) [3–5], and is becoming increasingly important because of the worldwide epidemic of overweight and obesity. As suggested by epidemiological studies, MetS is atypical condition of middle aged and older people. Inflammation is a complex, highly orchestrated process in
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