Elevation of C-Reactive Protein in “Active” Coronary Artery Disease Bradford C. Berk, MD, PhD, William S. Weintraub, MD, and R. Wayne Alexander, MD, PhD

Unstable angina occurs most commonly in the setting of atherosclerotic coronary artery disease (CAD), but there is little information concerning the mechanisms responsible for the transition from clinically stable to unstable coronary atherosclerotic plaque. Recently, imreased focal infiltration of intlammatory cells into the adventitia of coronary arteries of patients dying suddenly from CAD and activation of chculating neutrophils in patients with unstable angina have been observed. To characterize the presence of inffammation in “active” atheroscierotic lesions, the acute phase reactant Creactive protein (CRP) was measured in 37 patients admitted to the coronary care unit with unstable angina, 30 patients admitted to the coronary care unit with nonischemic illnesses and ,332patients with stable CAD. CRP levels were significantly elevated (normal 150/90 mm Hg Total serum cholesterol (mg/dl) Current medications la blockers Calcium antagonists Diuretics Nitrates Aspirin C-reactive protein (mg/dl)

Study

Groups

Unstable Angina

Nonischemic Coronary Care

Stable Angina

p Value*

39 63+ 16 21/18 30 37 14 6 16 10 20 246f57

30 57f 16 11/19 6 10 6 7 9 4 9 218480

32 59f9 26/6 3 0 12 2 14 3 10 232f48

NS NS 0.002 (NS. 0.015) 0.001 (0.001,0.001) 0.001 (0.001,0.001) NS NS NS NS NS NS

23 22 11 24 3 2.2 f 2.9

7 9 13 9 0 0.9 f 0.7

20 23 4 23 6 0.7 f 0.2

0.003 0.004 0.025 0.003 0.033 0.001

(0.003. NS) (0.030. NS) (NS, 0.110) (0.009, NS) (NS, 0.160) (0.020,0.004)

l Comparisons between patient study groups were Initially performed by chi-square tests for discontinuous variables and by l-way analysis of variance for continuous variables. Where significant dfferences (p 20%. These 5 patients also had normal exercise tests and therefore were reclassified to the coronary care unit group without unstable angina. Only 1 of these patients had an elevated CRP value. C-reactive protein measurements: As shown in Figure 1, 35 patients (90%) with a final diagnosisof unstable angina had CRP values (range 0.65 to 15.0 mg/dl) above the upper limit of normal (0.3 mm, occurring >3 times/day). As shown in Figure 2 there were significant fluctuations in CRP values that bore some associationwith both clinical symptoms and electrocardiographic changes.In patient 2 the inability to manage unstable angina medically was mirrored in the progressive increasein CRP before coronary artery bypasssurgery.

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Elevation of C-reactive protein in "active" coronary artery disease.

Unstable angina occurs most commonly in the setting of atherosclerotic coronary artery disease (CAD), but there is little information concerning the m...
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