CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 7, August 2013
270
AFRICA
Increased carotid intima–media thickness associated
with high hs-CRP levels is a predictor of unstable
coronary artery disease
SEJRAN AHMET ABDUSHI, FADIL UKË KRYEZIU, FEIM DURAK NAZREKU
Abstract
Increased values of carotid intima–media thickness (CIMT)
and high-sensitivity C-reactive protein (hs-CRP) are predic-
tors of acute coronary events. We analysed the link between
CIMT and hs-CRP in cases with coronary artery disease
(CAD). From 1 January to 30 June 2012, we evaluated 43
patients with acute coronary syndrome (groupA), 50 patients
with stable coronary artery disease (group B) and 50 healthy
volunteers (group C). All were analysed for CIMT and
hs-CRP levels. CIMT values were higher in groups A and B
(0.94
±
0.21 mm, 0.89
±
0.19 mm, respectively) and lower in
group C (0.64
±
0.09 mm), and this was statistically signifi-
cant (
p
<
0.0001). However the values of hs-CRP were higher
in group A (1.87
±
0.36 mg/l) and lower in groups B and C
(1.07
±
0.28 mg/l, 0.97
±
0.45 mg/l, respectively) and this was
also statistically significant (
p
<
0.0001).
Keywords:
CIMT, hs-CRP, atherosclerosis, stable coronary
disease, unstable coronary disease
Submitted 12/5/13, accepted 14/8/13
Cardiovasc J Afr
2013;
24
: 270–273
DOI: 10.5830/CVJA-2013-061
More than half of acute myocardial infarctions originate from
blood vessels with stenosis of less than 50%.
1
Moreover,
cholesterol level is a poor predictor of cardiovascular risk. This
was documented by data from the FraminghamHeart study, where
more than a third of patients with coronary artery disease (CAD)
had values of total cholesterol lower than 5.1 mmol/l.
2
A method
is therefore needed to improve prediction of cardiovascular risk.
During the 1990s it became clear that many other factors besides
conventional risk factors, such as homeostatic and thrombotic
mechanisms, markers of inflammation and genetic risk factors
may have an influence on cardiovascular risk.
3-9
For pathogenesis of coronary artery disease, the presence
of atherosclerotic plaques is significant.
4
The structure of the
coronary artery wall is not static. With increase in its external
diameter, development of atherosclerotic plaques will be possible
without significant narrowing of the lumen of the artery.
10
Several necropsy studies have reported very strong correlations
between atherosclerosis in the carotid and coronary arteries.
11,12
Increase in carotid artery intima–media thickness (CIMT) is
considered a marker for early atherosclerosis.
13
Risk prediction
for coronary artery disease may be improved by additional
information on the increase in CIMT, together with traditional
risk factors.
14
Recently, inflammation has emerged as an important factor
in the process of atherosclerosis,
15
therefore hs-CRP has been
included as a new risk factor for CAD.
16
In a recent study it was
concluded that both hs-CRP and conventional lipid parameters
can be used to predict the risk for CAD.
17
Exercise stress testing provides useful information on the
prognosis of patients with stable CAD and stable patients after
acute coronary syndrome.
18
Myers
et al.
found that subjects with
stable CAD who achieved
<
5 METs (metabolic equivalents) in
exercise stress tests had four times higher mortality rates than
subjects who achieved
>
10 METs.
19
The aim of this study was to analyse the association between
changes in CIMT and hs-CRP values in cases with stable and
unstable coronary artery disease.
Methods
Between 1 January and 30 June 2012, a total of 143 subjects
were included in this prospective study. All subjects were
placed in three groups: group A (patients with acute coronary
syndrome) included 43 patients with acute coronary artery
syndrome, 25 (58.14%) with acute myocardial infarction and
18 (41.86%) with unstable angina pectoris. Group B included
50 patients with stable coronary artery disease, 37 (74%) of
them with stable angina pectoris and 13 (26%) with a stable
condition after myocardial infarction, and all achieved
≥
5 METs
in exercise stress testing. Group C (control group) included 50
healthy volunteers with negative exercise stress testing.
We excluded all subjects with acute infection, active chronic
inflammatory diseases (inflammatory bowel disease, rheumatic
diseases, upper and lower respiratory tract diseases, etc.), patients
after a recent myocardial infarction (less than one month before
the study onset), patients with recent trauma (surgery, burns)
and those with malignancies. Adjustment was made for age and
gender. All individuals were interviewed about risk factors and
regularity of therapy.
Routine biochemical analyses were performed, with special
emphasis on fasting glucose levels and lipid profiles [total
cholesterol, low-density lipoprotein (LDL) cholesterol, high-
density lipoprotein (HDL) cholesterol and triglycerides]. In
group A, blood samples for hs-CRP were obtained on admission,
and at a time interval shorter than six hours from the onset
of symptoms, and stored at –70°C. We also took samples for
cardiac (troponin I, myoglobin, CK-MB) enzymes.
Carotid ultrasound was done by a single operator using an
Aloka-Prosound SSD-4000SV system equipped with a 7.5-MHz
Prim Dr Daut Mustafa Regional Hospital, Prizren, Republic
of Kosovo
SEJRAN AHMET ABDUSHI, MSc,
FEIM DURAK NAZREKU, MSc
National Institute of Public Health, Prizren, Republic of
Kosovo
FADIL UKË KRYEZIU, MSc
