Genetically Elevated C-Reactive Protein and Ischemic Vascular Disease
In a study of four cohorts of patients from Denmark, the subjects were typed for four single-nucleotide polymorphisms in the gene for C-reactive protein (CRP). The resulting genotypes were correlated with an increase in CRP levels of up to 64%, a result predicting significantly increased risks of is...
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Published in | The New England journal of medicine Vol. 359; no. 18; pp. 1897 - 1908 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Boston, MA
Massachusetts Medical Society
30.10.2008
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Subjects | |
Online Access | Get full text |
ISSN | 0028-4793 1533-4406 1533-4406 |
DOI | 10.1056/NEJMoa0707402 |
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Abstract | In a study of four cohorts of patients from Denmark, the subjects were typed for four single-nucleotide polymorphisms in the gene for C-reactive protein (CRP). The resulting genotypes were correlated with an increase in CRP levels of up to 64%, a result predicting significantly increased risks of ischemic heart disease and ischemic cerebrovascular disease. However, no such increase in risk was observed, a result suggesting that the known association between CRP levels and vascular risk is not causal.
Four cohorts of patients were typed for four single-nucleotide polymorphisms in the gene for C-reactive protein (CRP). Although the resulting genotypes were correlated with an increase in CRP levels of up to 64%, no increase in risk of ischemic heart disease or ischemic cerebrovascular disease was observed, suggesting that the association between CRP levels and vascular risk is not causal.
Elevated plasma levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart disease and ischemic cerebrovascular disease.
1
–
5
However, whether CRP is simply a marker for ischemic vascular disease or whether elevated CRP levels actually contribute directly to causing such disorders is presently unknown. This question has clinical importance, since several drugs that specifically lower CRP levels are being developed,
6
with the ultimate aim of preventing ischemic vascular disease.
The random assortment of genes that occurs during gamete formation provides a relatively unbiased method of assessing whether risk factors that have a genetic component are in fact . . . |
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AbstractList | Elevated levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart disease and ischemic cerebrovascular disease. We tested whether this is a causal association.
We studied 10,276 persons from a general population cohort, including 1786 in whom ischemic heart disease developed and 741 in whom ischemic cerebrovascular disease developed. We examined another 31,992 persons from a cross-sectional general population study, of whom 2521 had ischemic heart disease and 1483 had ischemic cerebrovascular disease. Finally, we compared 2238 patients with ischemic heart disease with 4474 control subjects and 612 patients with ischemic cerebrovascular disease with 1224 control subjects. We measured levels of high-sensitivity CRP and conducted genotyping for four CRP polymorphisms and two apolipoprotein E polymorphisms.
The risk of ischemic heart disease and ischemic cerebrovascular disease was increased by a factor of 1.6 and 1.3, respectively, in persons who had CRP levels above 3 mg per liter, as compared with persons who had CRP levels below 1 mg per liter. Genotype combinations of the four CRP polymorphisms were associated with an increase in CRP levels of up to 64%, resulting in a theoretically predicted increased risk of up to 32% for ischemic heart disease and up to 25% for ischemic cerebrovascular disease. However, these genotype combinations were not associated with an increased risk of ischemic vascular disease. In contrast, apolipoprotein E genotypes were associated with both elevated cholesterol levels and an increased risk of ischemic heart disease.
Polymorphisms in the CRP gene are associated with marked increases in CRP levels and thus with a theoretically predicted increase in the risk of ischemic vascular disease. However, these polymorphisms are not in themselves associated with an increased risk of ischemic vascular disease. Background Elevated levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart disease and ischemic cerebrovascular disease. We tested whether this is a causal association. Methods We studied 10,276 persons from a general population cohort, including 1786 in whom ischemic heart disease developed and 741 in whom ischemic cerebrovascular disease developed. We examined another 31,992 persons from a cross-sectional general population study, of whom 2521 had ischemic heart disease and 1483 had ischemic cerebrovascular disease. Finally, we compared 2238 patients with ischemic heart disease with 4474 control subjects and 612 patients with ischemic cerebrovascular disease with 1224 control subjects. We measured levels of high-sensitivity CRP and conducted genotyping for four CRP polymorphisms and two apolipoprotein E polymorphisms. Results The risk of ischemic heart disease and ischemic cerebrovascular disease was increased by a factor of 1.6 and 1.3, respectively, in persons who had CRP levels above 3 mg per liter, as compared with persons who had CRP levels below 1 mg per liter. Genotype combinations of the four CRP polymorphisms were associated with an increase in CRP levels of up to 64%, resulting in a theoretically predicted increased risk of up to 32% for ischemic heart disease and up to 25% for ischemic cerebrovascular disease. However, these genotype combinations were not associated with an increased risk of ischemic vascular disease. In contrast, apolipoprotein E genotypes were associated with both elevated cholesterol levels and an increased risk of ischemic heart disease. Conclusions Polymorphisms in the CRP gene are associated with marked increases in CRP levels and thus with a theoretically predicted increase in the risk of ischemic vascular disease. However, these polymorphisms are not in themselves associated with an increased risk of ischemic vascular disease. Elevated levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart disease and ischemic cerebrovascular disease. We tested whether this is a causal association.BACKGROUNDElevated levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart disease and ischemic cerebrovascular disease. We tested whether this is a causal association.We studied 10,276 persons from a general population cohort, including 1786 in whom ischemic heart disease developed and 741 in whom ischemic cerebrovascular disease developed. We examined another 31,992 persons from a cross-sectional general population study, of whom 2521 had ischemic heart disease and 1483 had ischemic cerebrovascular disease. Finally, we compared 2238 patients with ischemic heart disease with 4474 control subjects and 612 patients with ischemic cerebrovascular disease with 1224 control subjects. We measured levels of high-sensitivity CRP and conducted genotyping for four CRP polymorphisms and two apolipoprotein E polymorphisms.METHODSWe studied 10,276 persons from a general population cohort, including 1786 in whom ischemic heart disease developed and 741 in whom ischemic cerebrovascular disease developed. We examined another 31,992 persons from a cross-sectional general population study, of whom 2521 had ischemic heart disease and 1483 had ischemic cerebrovascular disease. Finally, we compared 2238 patients with ischemic heart disease with 4474 control subjects and 612 patients with ischemic cerebrovascular disease with 1224 control subjects. We measured levels of high-sensitivity CRP and conducted genotyping for four CRP polymorphisms and two apolipoprotein E polymorphisms.The risk of ischemic heart disease and ischemic cerebrovascular disease was increased by a factor of 1.6 and 1.3, respectively, in persons who had CRP levels above 3 mg per liter, as compared with persons who had CRP levels below 1 mg per liter. Genotype combinations of the four CRP polymorphisms were associated with an increase in CRP levels of up to 64%, resulting in a theoretically predicted increased risk of up to 32% for ischemic heart disease and up to 25% for ischemic cerebrovascular disease. However, these genotype combinations were not associated with an increased risk of ischemic vascular disease. In contrast, apolipoprotein E genotypes were associated with both elevated cholesterol levels and an increased risk of ischemic heart disease.RESULTSThe risk of ischemic heart disease and ischemic cerebrovascular disease was increased by a factor of 1.6 and 1.3, respectively, in persons who had CRP levels above 3 mg per liter, as compared with persons who had CRP levels below 1 mg per liter. Genotype combinations of the four CRP polymorphisms were associated with an increase in CRP levels of up to 64%, resulting in a theoretically predicted increased risk of up to 32% for ischemic heart disease and up to 25% for ischemic cerebrovascular disease. However, these genotype combinations were not associated with an increased risk of ischemic vascular disease. In contrast, apolipoprotein E genotypes were associated with both elevated cholesterol levels and an increased risk of ischemic heart disease.Polymorphisms in the CRP gene are associated with marked increases in CRP levels and thus with a theoretically predicted increase in the risk of ischemic vascular disease. However, these polymorphisms are not in themselves associated with an increased risk of ischemic vascular disease.CONCLUSIONSPolymorphisms in the CRP gene are associated with marked increases in CRP levels and thus with a theoretically predicted increase in the risk of ischemic vascular disease. However, these polymorphisms are not in themselves associated with an increased risk of ischemic vascular disease. In a study of four cohorts of patients from Denmark, the subjects were typed for four single-nucleotide polymorphisms in the gene for C-reactive protein (CRP). The resulting genotypes were correlated with an increase in CRP levels of up to 64%, a result predicting significantly increased risks of ischemic heart disease and ischemic cerebrovascular disease. However, no such increase in risk was observed, a result suggesting that the known association between CRP levels and vascular risk is not causal. Four cohorts of patients were typed for four single-nucleotide polymorphisms in the gene for C-reactive protein (CRP). Although the resulting genotypes were correlated with an increase in CRP levels of up to 64%, no increase in risk of ischemic heart disease or ischemic cerebrovascular disease was observed, suggesting that the association between CRP levels and vascular risk is not causal. Elevated plasma levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart disease and ischemic cerebrovascular disease. 1 – 5 However, whether CRP is simply a marker for ischemic vascular disease or whether elevated CRP levels actually contribute directly to causing such disorders is presently unknown. This question has clinical importance, since several drugs that specifically lower CRP levels are being developed, 6 with the ultimate aim of preventing ischemic vascular disease. The random assortment of genes that occurs during gamete formation provides a relatively unbiased method of assessing whether risk factors that have a genetic component are in fact . . . |
Author | Tybjærg-Hansen, Anne Nordestgaard, Børge G Zacho, Jeppe Jensen, Jan Skov Sillesen, Henrik Grande, Peer |
Author_xml | – sequence: 1 givenname: Jeppe surname: Zacho fullname: Zacho, Jeppe – sequence: 2 givenname: Anne surname: Tybjærg-Hansen fullname: Tybjærg-Hansen, Anne – sequence: 3 givenname: Jan Skov surname: Jensen fullname: Jensen, Jan Skov – sequence: 4 givenname: Peer surname: Grande fullname: Grande, Peer – sequence: 5 givenname: Henrik surname: Sillesen fullname: Sillesen, Henrik – sequence: 6 givenname: Børge G surname: Nordestgaard fullname: Nordestgaard, Børge G |
BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20811071$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/18971492$$D View this record in MEDLINE/PubMed |
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CODEN | NEJMAG |
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Keywords | Medicine Vascular disease Acute phase protein Ischemia Cardiovascular disease Genetics C reactive protein |
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Snippet | In a study of four cohorts of patients from Denmark, the subjects were typed for four single-nucleotide polymorphisms in the gene for C-reactive protein (CRP).... Elevated levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart disease and ischemic cerebrovascular disease. We tested... Background Elevated levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart disease and ischemic cerebrovascular disease. We... |
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SubjectTerms | Atherosclerosis - blood Biological and medical sciences Biomarkers - blood Blood tests C-Reactive Protein - analysis C-Reactive Protein - genetics Cardiovascular disease Causality Cerebrovascular Disorders - blood Cerebrovascular Disorders - genetics Cohort Studies Cross-Sectional Studies Female General aspects Genetic Predisposition to Disease Genotype & phenotype Humans Male Medical sciences Myocardial Ischemia - blood Myocardial Ischemia - genetics Polymorphism, Genetic Proteins Risk Factors |
Title | Genetically Elevated C-Reactive Protein and Ischemic Vascular Disease |
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