C-reactive protein and coronary heart disease in western Turkey

C-reactive protein (CRP) has been recognized as a useful marker for coronar y or cardiovascular risk in healthy subjects or patients with coronary hear t disease (CND) in industrialized societies. We assessed whether CRP could serve as a marker of prevalent CHD risk in a cross-sectional study of a pop ulation with low cholesterol levels (4.61 mmol/L in men and 4.82 mmol/L in women) but higher prevalence of other risk factors. In 1,046 participants o f the Turkish Adult Risk Factor Survey in 2000, high-sensitivity CRP as wel l as other risk variables were evaluated, and CHD was diagnosed, based on c linical findings and Minnesota coding of electrocardiograms at rest. Almost an equal number of men and women greater than or equal to 30 years of age constituted the population sample of the western regions of Turkey. Geometr ic mean value of CRP was 1.9 mg/L (interquartile range 0.8 to 4.3), without revealing a significant difference in gender. CRP was correlated with many variables, notably those involving central obesity, fibrinogen, and apolip oprotein-B, but not with smoking status (regardless of age adjustment). In multiple regression models, blood fibrinogen, waist circumference, total ch olesterol, and physical activity grade were independently associated with l og CRP concentrations. Among many risk variables, CRP quartiles and systoli c blood pressure were, besides age and gender, the only significant indepen dent determinants of CHD. The age-adjusted odds ratio for CHD in the highes t as opposed to the lowest quartile was 4.48 (p <0.001). Even after adjustm ent for the 5 previously mentioned determinants of CRP, a 4.2-fold increase d risk of CHD still persisted between the highest and lowest quartiles. Thu s, the observed increased risk was not in large part due to the intermediar y effects of fibrinogen, nor were some indicators of insulin resistance, bu t interaction appeared to be independent of these effects. Thus, CRP values serve as a marker of prevalent CHD risk in populations with low cholestero l levels. This association is independent of, or in addition to, the effect s of conventional risk factors, suggesting that the contribution of chronic low-grade inflammation to the atherothrombotic process is present even in the setting of low cholesterol levels. (C) 2001 by Excerpta Medica, Inc.