Michael J Blaha1; Juan J Rivera1; Matthew Budoff2; Ron Blankstein3; Arthur Agatston4; Dan H O’Leary5; Roger S Blumenthal6; Khurram Nasir6
1 Johns Hopkins Hosp， Baltimore， MD
2 Los Angeles Biomedical Rsch Institute at Harbor-UCLA， Torrance， CA
3 Brigham and Women’s Hosp， Non-invasive Cardiovascular Imaging Program， Boston， MA
4 South Beach Preventive Cardiology Cntr， Univ of Miami， Miami Beach， FL
5 Carney Hosp， Dorchester， MA
6 Johns Hopkins Hosp， Baltimore， MD
Background: The JUPITER trial has led to increasing interest in the use of high-sensitivity C-reactive protein (hsCRP) as a screening tool for initiating lipid-lowering therapy. hsCRP is an inflammatory marker that is markedly correlated with traditional cardiovascular risk factors， including anthropomorphic measures of obesity ( =0.40 – 0.55). To help elucidate the implications of hsCRP measurement， we conducted a stratified analysis of the relationship between obesity， hsCRP>=2， and subclinical atherosclerosis.
Methods: MESA is a longitudinal， population-based study of 6，814 men and women aged 45– 84 without clinical cardiovascular disease at enrollment. 4，533 individuals had baseline LDL-C <130 mg/dL. Body mass index (BMI) and hsCRP were measured at baseline， and all participants underwent non-contrast cardiac CT to measure coronary artery calcium (CAC) as well as carotid ultrasound to determine carotid intima-media thickness (CIMT). Patients were divided into 4 groups: non-obese/hsCRP<2， non-obese/hsCRP>=2， obese/hsCRP<2， obese/hsCRP>=2. Obesity was defined as BMI >=30 kg/m2. We then used multivariable logistic and robust linear regression to describe the association between obesity， hsCRP， CAC， and cIMT. CAC and cIMT were considered as binary (CAC>0， CIMT >75th percentile) and continuous variables in separate analyses.
Results: The mean BMI of the population was 28.3±5.5 kg/m2， and median hsCRP was 1.9 mg/dL (0.84–4.26). Approximately 32% were classified as obese， and 48% had hsCRP>=2. BMI and hsCRP were moderately correlated ( =0.42). The results of the analysis are shown below.
Conclusion: Within MESA， non-obese individuals with hsCRP>=2 have slightly increased CIMT， while obese individuals with hsCRP<2 have substantially increased CAC and CIMT. Anthropomorphic data can be measured non-invasively and cost-free in clinical medicine， raising the possibility of using obesity rather than hsCRP>=2 for parsimonious risk stratification.