IJCRR - 4(2), January, 2012
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A STUDY OF ASSOCIATION BETWEEN C-REACTIVE PROTEIN AND FEATURES OF METABOLIC
Author: Abhijit Basu, Jitendra Ahuja
Abstract:Objective \- To study the clinical profile of patients with metabolic syndrome and find out the
association of CRP level with components of the metabolic syndrome.
Research Design And Methods\- We conducted a cross-sectional prospective study in 50
cases of metabolic syndrome randomly selected from medical wards of a tertiary care hospital.
Total cholesterol (TC), HDL cholesterol, triglycerides, BMI, waist circumference and
prevalence of diabetes and hypertension were assessed. To define the metabolic syndrome we
used modified ATP III criteria recommended in AHA/NHLBI statement. Complete information
for the five variables needed to assess the metabolic syndrome was collected. CRP was
measured by latex enhanced immunoturbidimetric assay (high sensitivity CRP assay).
Results\- Higher waist circumference cases had higher mean hs-CRP (3.235 Vs 1.950, P
< 0.0001). Elevated diastolic blood pressure cases had higher mean hs-CRP level (3.264 Vs
2.221, P < 0.05) Conclusions\-Waist circumference was significantly and independently
associated with high hs-CRP levels. The data suggest that hs-CRP value significantly increased
with increase in the number of features of metabolic syndrome.
INTRODUCTION The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin – ?metabolic risk factors?- that appear to directly promote the development of atherosclerotic cardiovascular disease.1 The term metabolic syndrome has been described variously by different groups and various syndromes are also to be found in literature such as syndrome X, 2 deadly quartet, hypertriglycerdemic waist3 and insulin resistance syndrome. Metabolic syndrome is driving the twin global epidemics of type 2 diabetes and cardiovascular disease. The prevalence of metabolic syndrome is estimated to be around 20-25 per cent of the population globally. People with metabolic syndrome are twice as likely to die from and three times as likely to have a heart attack or stroke compared with people without the syndrome.4 In addition, almost 200 million people globally have diabetes and 80 percent of these will die from cardiovascular disease,5 so there is an overwhelming moral, medical and economic imperative to identify these individuals with metabolic syndrome early, so that life style interventions and treatment may prevent the development of diabetes and/or cardiovascular disease. A number of expert groups have developed clinical criteria for the metabolic syndrome. The most widely accepted of these have been produced by the WHO, the European group for the study of insulin resistance (EGIR) and NCEP ATP III.6 All Groups agree on the core components of the metabolic syndrome: obesity, insulin resistance, dyslipidemia and hypertension. However, they apply the criteria differently to identify such a cluster.
Metabolic syndrome and C-reactive protein People with the metabolic syndrome frequently have a proinflammatory state as shown by elevated cytokines, i.e., TNF and IL-6 and acute phase reactants i.e. CRP, fibrinogen. Estimation of CRP is relatively easy to identify a proinflammatory and inflammatory condition in routine clinical practice. It has been suggested that testing CRP level in blood may be new way to access cardiovascular disease risk, finding of an elevated level support the need for life style changes. Weight reduction may diminish CRP levels and apparently will alleviate the underlying, inflammatory stimulus.
Aims and Objectives This study was conducted with the following aims and objectives:
Diagnostic criteria for metabolic syndrome: Modified ATP III criteria 7, 8 recommended in AHA/ NHLBI statement will be used for diagnosis of metabolic syndrome which is as follows:
1. National Cholesterol Education Programme (NCEP) expert panel on detection and treatment of high blood cholesterol in adults (ATP-III). Circulation, 2002: 106:3143-3421.
2. Reaven GM. Role of insulin resistance in human disease (syndrome X) an expanded definition. Ann Rev Med. 1993: 44:121-131.
3. Lemieux I, Pascot A, Couillard C, Lamarche B, Tcherno FA, Almevas N, Begeron J, Gaudet D, Tremblay G, Prud`homme D, Nadeau A, Despres JP. Hypertriglycerdemic waist: a maker of the atherogenic metabolic trial (hyperinsulinemia, hyperapolipoprotein B; small dense LDL) in men. Circulation, 2000; 102:179-184.
4. Isomaa B, Almgren P, Tuomi T et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes care, 2001; 24(4):683-9.
5. Diabetes Atlas. Second edition, International diabetes federation, 2003.
6. Executive summary of the III report of the National Cholesterol Education Programme (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult treatment panel III). JAMA, 2001; 285:2486-97.
7. Shiwaku K, Nogi A, Kitajima K et al. Prevalence of the metabolic syndrome using the modified ATP III definitions for workers in Japan, Korea , and Mongolia. J occup health , 2005: 47:126-135.
8. Lorenzo C, Serrano-Rios M et al. Central obesity determines prevalence differences of the metabolic syndrome. Obes Res, 2003; 11:1480-1487