Relationship Between High-sensitivity C-reactive Protein And Carotid Atherosclerosis Stratified By Weight In Adults

Objective:Atherosclerosis has become the most important global public health issue.There is a compelling relationship between inflammatory/obesity and carotid atherosclerosis.The aim of the present study is to assess the relationship between inflammatory levels and carotid atherosclerosis,stratified by weight in a general population,to provide strategies for the prevention and treatment of atherosclerosis.The subjects were categorized as normal weight,overweight,and obese by body mass index(BMI).Methods:The study performed a large cross-sectional study among population from the Tianjin Chronic Low-Grade Systemic Inflammation and Health Cohort Study.After inclusion and exclusion criteria,7985 participants were enrolled into this study.Investigators collected the physical examination,laboratory examination and questionnaires data.Measurements of carotid atherosclerosis were performed using a carotid artery B-mode ultrasound system.The subjects were categorized as normal weight(BMI<24 kg/m2),overweight(24 ≤ BMI<28 kg/m2),and obesity(BMI ≥ 28 kg/m2)in accordance with the criteria of Chinese Standard for Adult BMI.High sensitivity C-reactive protein(hs-CRP)as an inflammatory indicator,was measured by immunoturbidimetric assay.Differences between groups with different BMI in total population,male population and female population were examined using analysis of variance(ANOVA)for continuous variables and logistic-regression analysis for categorical variables.Multiple logistic models were used to assess the stratified relationships between hs-CRP levels and carotid atherosclerosis in total population,male population and female population.Analysis of covariance(ANCOVA)was used to assess the stratified relationships between hs-CRP levels and carotid plaque area in total population,male population and female population.Strata were defined according to BMI.Results:The prevalence of increased carotid intima-media thickness(cIMT)and plaques were 27.4%and 21.3%in total population,33.3%and 25.0%in male population,19.3%and 16.3%in female population,respectively.In total population,after adjustments for all potential confounding factors,such as age,sex,BMI,smoking status,drinking status,hypertension,hyperlipidaemia,diabetes,inflammatory disease,metabolic syndrome and the family history of cardiovascular diseases,hypertension,hyperlipidaemia and diabetes,the adjusted odds ratios(95%confidence interval,95%CI)for cIMT across hs-CRP quartiles were as follows:1.00(reference),0.70(0.48,1.04),1.04(0.72,1.50)and 1.26(0.89,1.80)(P for trend<0.01)in normal weight subjects;1.00(reference),1.08(0.84,1.39),1.33(1.04,1.70)and 1.31(1.02,1.67)(P for trend<0.05)in overweight subjects;1.00(reference),0.62(0.44,0.87),0.85(0.61,1.18)and 0.89(0.63,1.25)(P for trend=0.79)in obese subjects,respectively.In male population,the adjusted odds ratios(95%CI)for cIMT across hs-CRP quartiles were as follows:1.00(reference),0.92(0.56,1.50),1.22(0.75,1.99)and 1.58(0.97,2.58)(P for trend<0.05)in normal weight subjects;1,00(reference),1.07(0.79,1.44),1.44(1.07,1.92)and 1.37(1.03,1.84)(P for trend<0.05)in overweight subjects;1.00(reference),0.88(0.59,1.30),1.02(0.69,1.50)and 1.14(0.76,1.71)(P for trend = 0.32)in obese subjects,respectively.In female population,the adjusted odds ratios(95%CI)for cIMT across hs-CRP quartiles were as follows:1.00(reference),0.58(0.32,1.05),1.05(0.62,1.81)and 1.03(0.62,1.72)(P for trend = 0.30)in normal weight subjects;1.00(reference),0.98(0.61,1.56),1.19(0.75,1.88)and 1.13(0.71,1.80)(P for trend = 0.51)in overweight subjects;1.00(reference),0.63(0.33,1.22),0.60(0.30,1.19)and 0.60(0.30,1.17)(P for trend = 0.24)in obese subjects,respectively.Similar results were observed for carotid plaques.In total population,after adjustments for all potential confounding factors,the adjusted least square mean(95%CI)for carotid plaque area across hs-CRP quartiles were as follows:2.24(1.34,3.74),2.49(1.49,4.16),2.25(1.35,3.77)and 2.65(1.59,4.41)(P<0.05)in normal weight subjects;2.92(1.15,7.42),3.15(1.24,8.02),3.55(1.40,9.05)and 3.77(1.48,9.58)(P<0.001)in overweight subjects;4.02(1.75,9.21),3.77(1.64,8.65),4.37(1.91,10.0)and 4.63(2.02,10.6)(P = 0.15)in obese subjects,respectively.In male population,the adjusted least square mean(95%Cl)for carotid plaque area across hs-CRP quartiles were as follows:2.52(1.14,5.60),2.97(1.34,6.61),2.68(1.21,5.95)and 3.49(1.57,7.74)(P<0.05)in normal weight subjects;3.01(1.13,8.04),3.30(1.23,8.83),3.65(1.36,9.79)and 4,21(1.58,11.3)(P<0.001)in overweight subjects;4.76(2.04,11.1),5.05(2.15,11.9),5.09(2.17,11.9)and 6.27(2.66,14.8)(P = 0.07)in obese subjects,respectively.In female population,the adjusted least square mean(95%CI)for carotid plaque area across hs-CRP quartiles were as follows:1.41(0.64,3.13),1.55(0.70,3.44),1.40(0.63,3.11)and 1.58(0.71,3.49)(P = 0.15)in normal weight subjects;2.04(0.57,7.38),2.17(0.60,7.90),2.50(0.69,9.08)and 2.20(0.61,7.97)(P = 0.21)in overweight subjects;1.82(0.42,7.98),1.96(0.45,8.54),2.12(0.49,9.20)and 1.92(0.45,8.18)(P = 0.86)in obese subjects,respectively.Conclusion:The results showed that hs-CRP levels are related to carotid atherosclerosis in normal and overweight men.But in obese men and all groups of women,the hs-CRP levels were not significantly related to carotid atherosclerosis.Further studies are needed to focus on the exact relationship between hs-CRP levels and carotid atherosclerosis and to explore the underlying mechanisms.