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C-Reactive Protein in the Detection of Inflammation

and It’s Role in Coronary Artery Disease

L.D. Hein, R.D. Muma
Department of Physician Assistant, Wichita State University
ABSTRACT Figure.1: Research Diagram
relation with short-term risk of death. This prospective, randomized, multicentered
Heart failure is becoming more common and increasing annually with coronary artery trial evaluated 917 patients over 37 months and found that CRP and fibrinogen were
disease (CAD) being the number one cause1. Current research is focused on detecting significantly higher in patients that died of cardiac causes, with CRP the superior
more risk factors and markers for atherosclerosis, with C-Reactive Protein (CRP) being C-Reactive Protein and it’s Role as a Marker in
the most widely studied due to its role in the atherosclerotic process leading to infarct2. the Detection of Inflammation and an Association
with Coronary Artery Disease.
In the WHS extension study, Ridker and colleagues proved that CRP was elevated in
The purpose of this study was to perform a systematic evidence-based literature review three components of the metabolic syndrome, all of which were associated with CAD.
addressing the issue of CAD and CRP. Medline was utilized to obtain adequate They also suggested that CRP had damaging effects on vessel walls5.
literature associated with certain, specific key terms. Articles were categorized into Key Terms: C-Reactive Protein (CRP), Coronary Artery
groups of evidence and separated into categories (grades) to answer the two main Disease (CAD), Inflammation, Marker, History,
Verma et al, implemented a cross-sectional analysis of human saphenous veins where
research questions: Is CRP a better marker for detection of inflammation? Is the Atherosclerosis, Underlying Cause, and Vessel Injury
they found the effects of CRP on the architecture of the dissected vessels and how CRP
presence of CRP associated with CAD? was associated IL-6, ET-1, ICAM-1, VCAM-1, MCP-1, and LDL. With CRP present there
was an increased secretion of ET-1, a very powerful vasoconstrictor. When IL-6 was
Forty-eight articles matched the desired criteria and were reviewed using evidence- Total Number of Articles elevated, CRP was present indicating plaque alteration in vessel architecture facilitating
based methods. All forty-eight articles determined that CRP was a superior marker in the n=48 plaque rupture. CRP assists in the up-regulation of ICAM-1 and VCAM-1 leading to
detection of inflammation. Twenty-four articles correlated CRP with CAD along with other elevated secretion of MCP-1, which promotes LDL uptake by macrophages. These
mediated factors of vessel disease, with most being group-one evidence. processes initiate inflammation and foam-cell formation leading to plaque instability and
Marker for Association with eventually plaque rupture6.
CRP is a superior marker of inflammation and plays an important role in the Inflammation Coronary Artery Disease
development of CAD. n=48 n=24 Figure 2: CRP as a Marker for Inflammation AND
PURPOSE: The purpose of this study was to determine the validity of CRP as Associated with CAD by Subcate gory
a marker for inflammation and to determine its association with CAD. The study 12
Group 1 Group 3 Group 5 Group 1 Group 3 Group 5
attempted to answer two main research questions: n=3 n=12 n=14 n=1 n=6 n=10
Group 2 Group 4 Group 6 Group 2 Group 4 Group 6 10
1. Is CRP a better marker for detection of inflammation? Control, Random,
n=12 n=9 n=2 n=4 n=3 n=2 Retro/ P rospective

Number of Citations
2. Is the presence of CRP associated with CAD? Cohort, and Case
8 Control

METHODS Cross Sectional

Setting. Wichita State University utilizing the library and online electronic resources. Results: C-Reactive Results: The presence of
Protein is a Marker of C-Reactive Protein is Background

Study population. A literature review was performed using the search engine of peer- Inflammation Associated with Coronary Information

reviewed articles obtained from Medline utilizing specific key terms including C-reactive n=52 Artery Disease 4
protein, coronary artery disease, inflammation, atherosclerosis, vessel injury, marker, (4 articles having 2 group n=26 Not Specified

history, and underlying cause. Articles were selected based on their content associated classifications) (2 articles having 2 group 2
with CRP and CAD. classifications)
Study design. Systematic evidence-based literature review from peer-reviewed articles Grade of Evidence
published in journals that addressed the issue of CAD and CRP. Outcome: C-Reactive Protein is a Marker of
Inflammation and Associated with
Measurements. Articles were categorized into levels of evidence and separated into Coronary Artery Disease
categories to answer the two main research questions. Data was placed into organized CONCLUSIONS
n=24 Articles The purpose of this study was to determine the validity of CRP as a marker for
tables utilizing Microsoft Excel. Column classifications include Study (year), Groups of
Evidence (I-VI), Number and Characteristics, Pertinent Findings, Valid Marker (Y/N), and inflammation and to determine its association with CAD. C-Reactive Protein is a
Associated With (Y/N). RESULTS superior marker for inflammation and plays a pivotal role in the atherosclerotic process.

Data collection. Upon completion of organized tables, data were evaluated based on the Study Findings. Fifty percent (n=24) of the articles that met inclusion criteria answered
both question one and two. Eleven articles met Grade A evidence, which is the
number of articles that answered the two main research questions. Calculations were REFERENCES
determined based on number of articles meeting criteria divided by total number of highest strength of recommendation3. Refer to Figure 2 for graphic representation.
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V:backgrouond information; VI:not specified in literature), grades of evidence (A:group I-III
evidence; B:group IV evidence; C:group V evidence; D:groupVI evidence), research
Stability in Coronary artery disease (FRISC) study group, factors such as troponin T,
CRP, and fibrinogen were evaluated in patients with unstable angina due to their

Lindahl B. The New England Journal of Medicine. Oct; 343(16):1139-1147.
Ridker P. Circulation. 2003; 107:r20-r26.
question one, and research question two. One research diagram and three bar graphs • Verma S. Circulation. 2002 Apr; 105:1890-1896.
were created using data collected from calculations. Refer to Figure.1 for diagram.