C-Reactive Proteins and Cardiovascular Risk Indices in Hypertensive Nigerians.

摘要

C-reactive protein (CRP), a biomarker of inflammation, has been found to play a role in the pathogenesis of cardiovascular disease and its determination has been proposed as one method of improving the prediction of the risk of cardiovascular events. CRP was determined in 150 hypertensive patients aged 30-59 years and 30 apparently healthy normotensive individuals matched for age and socioeconomic status by ELISA technique. Atherogenic index (LDL-C/HDL-C) and coronary heart disease risk (HDL-C/TC) were also calculated from the lipid profile. Among the hypertensive patients, only 1 (1.2%) female had a dangerous coronary heart disease risk, while 14 (9.3%) (6 males and 8 females) were at high risk of CHD and only 16 (10.7%) (11 males and 5 females) had probable protection against CHD. Hypertensive patients were significantly (p < 0.05) heavier than the normotensive patients (28.34 ± 4.40kg/m2 vs. 25.79 ± 2.91kg/m2), with significantly higher atherogenic indices and CRP. Among the hypertensive patients, CRP positively correlated with atherogenic index (r = 0.551, p < 0.05) and CHD risk (r = 0.589, p < 0.05). However, in normotensive patients, CRP was positively correlated with atherogenic index (r = 0.492, p < 0.01) but negatively correlated with CHD risk (r = -0.475, p < 0.01). In conclusion, hypertensive Nigerians have significantly higher CRP than their normotensive counterparts, which correlates with CHD risk. Introduction The role of inflammation in the pathogenesis of atherosclerosis is well established [12]. The increasing recognition of inflammation as an important component of atherogenesis provides the plausibility for the potential use of inflammation markers such as c-reactive protein (CRP), interleukin-6 (IL-6) and serum amyloid A (SAA) as indicators for atherogenesis or as a predictor of atherosclerosis/ or coronary heart disease complications [3456]. Although these inflammation markers are not specific as they may arise from other systemic inflammation, such as with connective tissue disease, local infection like gingivitis or prostatitis , studies have shown a relationship between high levels of these markers and high incidence of CHD and sudden death [278]. For instance, it has been found that the risk for heart attack in people in the upper third of high sensitivity C-reactive protein (hs-CRP) levels (< 0.3mg/dl) is twice that of those whose hs-CRP is in the lower third [9]. It has been reported that CRP is useful in predicting the risk of heart disease and stroke. CRP as an index of inflammation is believed to promote directly all stages of atherosclerosis, including plaque rupture and its measurement has been found to provide a clinical tool for cardiovascular risk assessment. Additionally, CRP has been found to independently predict recurrent events in patients with known CAD [10]. Paucity of data on CRP in hypertensive Nigerians prompted us to conduct this research. The objective is to provide scientific information that may have clinical relevance in the management of hypertension in Nigeria. Subjects And Methods Subjects: This study was conducted in the Department of Chemical Pathology in conjunction with the Department of Internal Medicine at the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. The protocol for the study was approved by the Research and Ethics Committee of the University of Benin Teaching Hospital. On obtaining consent, hypertensive patients (diagnosed by a Consultant Physician in the Department of Internal Medicine of the University of Benin Teaching Hospital based on World Health Organisation-International Society of Hypertension Guideline of blood pressure ≥ 140/90mmHg) aged 30-59 years were recruited. Inclusion criteria included being hypertensive for ≥ one year, use of neutral antihypertensive agents such as calcium channel blockers, angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers. Excluded from the study were patients with diabete