Editing C-reactive protein (section)

=== Cardiovascular disease ===

Recent research suggests that patients with elevated basal levels of CRP are at an increased risk of [[diabetes]],<ref name="pmid11466099">{{cite journal | vauthors = Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM | title = C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus | journal = JAMA | volume = 286 | issue = 3 | pages = 327–334 | date = July 2001 | pmid = 11466099 | doi = 10.1001/jama.286.3.327 | doi-access = free }}</ref><ref name="pmid17327459">{{cite journal | vauthors = Dehghan A, Kardys I, de Maat MP, Uitterlinden AG, Sijbrands EJ, Bootsma AH, Stijnen T, Hofman A, Schram MT, Witteman JC | title = Genetic variation, C-reactive protein levels, and incidence of diabetes | journal = Diabetes | volume = 56 | issue = 3 | pages = 872–878 | date = March 2007 | pmid = 17327459 | doi = 10.2337/db06-0922 | doi-access = free }}</ref> [[hypertension]] and [[cardiovascular disease]]. A study of over 700 nurses showed that those in the highest [[quartile]] of [[trans fat]] consumption had blood levels of CRP that were 73% higher than those in the lowest quartile.<ref name="pmid15735094">{{cite journal | vauthors = Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, Willett WC, Hu FB | title = Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction | journal = The Journal of Nutrition | volume = 135 | issue = 3 | pages = 562–566 | date = March 2005 | pmid = 15735094 | doi = 10.1093/jn/135.3.562 | doi-access = free }}</ref> Although one group of researchers indicated that CRP may be only a moderate risk factor for cardiovascular disease,<ref name="pmid15070788">{{cite journal | vauthors = Danesh J, Wheeler JG, Hirschfield GM, Eda S, Eiriksdottir G, Rumley A, Lowe GD, Pepys MB, Gudnason V | title = C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease | journal = The New England Journal of Medicine | volume = 350 | issue = 14 | pages = 1387–1397 | date = April 2004 | pmid = 15070788 | doi = 10.1056/NEJMoa032804 | doi-access = free }}</ref> this study (known as the Reykjavik Study) was found to have some problems for this type of analysis related to the characteristics of the population studied, and there was an extremely long follow-up time, which may have attenuated the association between CRP and future outcomes.<ref>Koenig, Wolfgang (2006). [https://archive.today/20120723185617/http://www.crphealth.com/conf/hcp/5,59/doctor.wolfgang.koenig.c-reactive.protein.%96.a.critical.cardiovascular.risk.html "C-reactive protein - a critical cardiovascular risk marker"]. CRPhealth.com.</ref> Others have shown that CRP can exacerbate [[ischemic]] [[necrosis]] in a [[complement (biology)|complement]]-dependent fashion and that CRP inhibition can be a safe and effective therapy for [[Myocardial infarction|myocardial]] and [[Cerebral infarction|cerebral]] [[infarct]]s; this has been demonstrated in animal models and humans.<ref name="pmid16642000">{{cite journal | vauthors = Pepys MB, Hirschfield GM, Tennent GA, Gallimore JR, Kahan MC, Bellotti V, Hawkins PN, Myers RM, Smith MD, Polara A, Cobb AJ, Ley SV, Aquilina JA, Robinson CV, Sharif I, Gray GA, Sabin CA, Jenvey MC, Kolstoe SE, Thompson D, Wood SP | title = Targeting C-reactive protein for the treatment of cardiovascular disease | journal = Nature | volume = 440 | issue = 7088 | pages = 1217–1221 | date = April 2006 | pmid = 16642000 | doi = 10.1038/nature04672 | s2cid = 4324584 | bibcode = 2006Natur.440.1217P | url = https://ro.uow.edu.au/cgi/viewcontent.cgi?article=6831&context=scipapers }}</ref><ref name="pmid37893085">{{cite journal | vauthors = Ding Z, Wei Y, Peng J, Wang S, Chen G, Sun J | title = The Potential Role of C-Reactive Protein in Metabolic-Dysfunction-Associated Fatty Liver Disease and Aging | journal = Biomedicines | volume = 11 | issue = 10 | date = October 2023 | page = 2711 | pmid = 37893085 | pmc = 10603830 | doi = 10.3390/biomedicines11102711 | doi-access = free | url = }}</ref><ref name="pmid35407379">{{cite journal | vauthors = Torzewski J, Brunner P, Ries W, Garlichs CD, Kayser S, Heigl F, Sheriff A | title = Targeting C-Reactive Protein by Selective Apheresis in Humans: Pros and Cons | journal = Journal of Clinical Medicine | volume = 11 | issue = 7 | date = March 2022 | page = 1771 | pmid = 35407379 | pmc = 8999816 | doi = 10.3390/jcm11071771 | doi-access = free | url = }}</ref>

It has been hypothesized that patients with high CRP levels might benefit from use of [[statins]]. This is based on the [[JUPITER trial]] that found that elevated CRP levels without hyperlipidemia benefited. Statins were selected because they have been proven to reduce levels of CRP.<ref name=Pepys/><ref name="pmid18997196">{{cite journal | vauthors = Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ | title = Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein | journal = The New England Journal of Medicine | volume = 359 | issue = 21 | pages = 2195–2207 | date = November 2008 | pmid = 18997196 | doi = 10.1056/NEJMoa0807646 | doi-access = free }}</ref> Studies comparing effect of various statins in hs-CRP revealed similar effects of different statins.<ref name="pmid22025854">{{cite journal | vauthors = Sindhu S, Singh HK, Salman MT, Fatima J, Verma VK | title = Effects of atorvastatin and rosuvastatin on high-sensitivity C-reactive protein and lipid profile in obese type 2 diabetes mellitus patients | journal = Journal of Pharmacology & Pharmacotherapeutics | volume = 2 | issue = 4 | pages = 261–265 | date = October 2011 | pmid = 22025854 | pmc = 3198521 | doi = 10.4103/0976-500X.85954 | doi-access = free }}</ref><ref name="pmid11306519">{{cite journal | vauthors = Jialal I, Stein D, Balis D, Grundy SM, Adams-Huet B, Devaraj S | title = Effect of hydroxymethyl glutaryl coenzyme a reductase inhibitor therapy on high sensitive C-reactive protein levels | journal = Circulation | volume = 103 | issue = 15 | pages = 1933–1935 | date = April 2001 | pmid = 11306519 | doi = 10.1161/01.CIR.103.15.1933 | doi-access = free }}</ref> A subsequent trial however failed to find that CRP was useful for determining statin benefit.<ref name="pmid21277016">{{cite journal | title = C-reactive protein concentration and the vascular benefits of statin therapy: an analysis of 20,536 patients in the Heart Protection Study | journal = Lancet | volume = 377 | issue = 9764 | pages = 469–476 | date = February 2011 | pmid = 21277016 | pmc = 3042687 | doi = 10.1016/S0140-6736(10)62174-5 | collaboration = Heart Protection Study Collaborative Group | vauthors = Jonathan E, Derrick B, Emma L, Sarah P, John D, Jane A, Rory C }}</ref>

In a [[meta-analysis]] of 20 studies involving 1,466 patients with [[coronary artery disease]], CRP levels were found to be reduced after exercise interventions. Among those studies, higher CRP concentrations or poorer lipid profiles before beginning exercise were associated with greater reductions in CRP.<ref name="pmid22520533">{{cite journal | vauthors = Swardfager W, Herrmann N, Cornish S, Mazereeuw G, Marzolini S, Sham L, Lanctôt KL | title = Exercise intervention and inflammatory markers in coronary artery disease: a meta-analysis | journal = American Heart Journal | volume = 163 | issue = 4 | pages = 666–76.e1–3 | date = April 2012 | pmid = 22520533 | doi = 10.1016/j.ahj.2011.12.017 }}</ref>

To clarify whether CRP is a bystander or active participant in [[atherogenesis]], a 2008 study compared people with various genetic CRP variants. Those with a high CRP due to genetic variation had no increased risk of cardiovascular disease compared to those with a normal or low CRP.<ref name="pmid18971492">{{cite journal | vauthors = Zacho J, Tybjaerg-Hansen A, Jensen JS, Grande P, Sillesen H, Nordestgaard BG | title = Genetically elevated C-reactive protein and ischemic vascular disease | journal = The New England Journal of Medicine | volume = 359 | issue = 18 | pages = 1897–1908 | date = October 2008 | pmid = 18971492 | doi = 10.1056/NEJMoa0707402 | doi-access = free }}</ref> A study published in 2011 shows that CRP is associated with lipid responses to low-fat and high-polyunsaturated fat diets.<ref name="pmid19297430">{{cite journal | vauthors = St-Onge MP, Zhang S, Darnell B, Allison DB | title = Baseline serum C-reactive protein is associated with lipid responses to low-fat and high-polyunsaturated fat diets | journal = The Journal of Nutrition | volume = 139 | issue = 4 | pages = 680–683 | date = April 2009 | pmid = 19297430 | pmc = 2666362 | doi = 10.3945/jn.108.098251 }}</ref>