Denesh, Narasimhan (2006) A study of correlation of C-Reactive Protein levels with carotid atherosclerotic plaques in dyslipidemic patients. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.
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Abstract
INTRODUCTION : Atherosclerosis is a inflammatory disease affecting the large and medium sized blood vessels.Serum levels of C-reactive protein, a major acute phase protein represents a clinical marker of inflammation. Recent data has revealed that CRP has been positively been associated with atherosclerosis. CRP has been found to be positively associated with acute myocardial infarction and with sudden deaths in patients with stable and unstable angina. Baseline levels of CRP in healthy subjects have been shown to predict development of symptomatic peripheral vascular disease. Coronary artery disease or both. An association between CRP and number of stenosed coronary vessels has been documented in coronary atherosclerosis. In relation to carotid atherosclerosis, two studies have shown the relation between CRP levels and carotid plaques.In one study there was a significant relation between CRP and early non-stenotic atherosclerosis. In anotherstudy there was correlation between CRP levels and prescence of atherosclerosis in the coronary, extracranial cerebrovascular and in the vasculature of the extremities. Patients without any of the conventional risk factors [smoking, diabetes mellitus, hypertension, dyslipidemia] for atherosclerosis are considered to be at low risk. As demonstrated in one study CRP is of special value only in patients in whom at least one of the four major risk factors are present.CRP is a proven risk factor in hypercholesteremic patients. Hence this study was focused on a group of dyslipidemic\ patients. AIM OF THE STUDY : The aim of the study is to determine whether CRP concentrations correlated with the prescence of carotid atherosclerotic plaques in a subset of dyslipidemic patients. MATERIALS AND METHODS : This study was conducted in forty dyslipidemic patients who attended the Medicine OPD at PSG Hospitals. INCLUSION CRITERIA: The inclusion criteria were as follows. Fasting serum lipid values; Total cholesterol > 200mg/dl, Triglycerides > 150mg/dl. EXCLUSION CRITERIA: Age < 18 and >70 years, CRP >10mg/l[ represents clinically relevant inflammation], HDL > 70mg/dl. DETERMINATION OF C-REACTIVE PROTEIN: Specimen Collection: Only disposable glass tubes were used for sample collection Blood samples were collected with aseptic precautions into a plain glass tube. • Method- Latex agglutination, • Carotid Doppler. In the supine position, with the head turned away from the sonographer and the neck extended with mild rotation, each patient systematically underwent ultrasonography of the extracranial carotid arteries by use of a duplex system.The protocol consisted of study of the right and left common and internal carotid arteries [including bifurcations] with use of 8-11 mega hertz scanning frequency in B -mode. Plaque was defined as an echogenic structure encroaching the vessel lumen with a distinct area 50% greater than the intimal plus medial thickness of neighbouring sites. RESULTS : The results of forty patients were analysed. Twenty four of the patients did not have plaques. Sixteen of them had plaques. The mean CRP of both the set of patients were calculated.The standard deviation w as calculated. The results were analysed by subjecting it to the null hypothesis. The null hypothesis was rejected and the p value was found to be significant.[p value - <0.001 / t value-3.9]. So CRP was found to correlate with prescence of atherosclerosis in dyslipedemic patients. CONCLUSION : This study was conducted on fourty dyslipidemic patients at PSG Hospitals, Coimbatore. All patients were subjected to a biochemical test in the form of C-Reactive Protein and simultaneously subjected to a carotid Doppler study by means of ultrasound. The C-Reactive Protein levels among patients with atherosclerotic plaques was found to be higher than in patients without plaques.[p value< 0.001]. The mean value of the CRP in patients without carotid plaques was found to be 0.61 and the mean values in the patients with carotid plaques was found to be0.86. Literature review showed few studies which showed an association between CRP levels and carotid atherosclerosis . There were other studies which showed association between CRP levels and atherosclerosis in other vascular beds such as the coronary circulation and the peripheral circulation. The present study showed the correlation of C-Reactive Protein levels with the prescence of carotid atherosclerosis. Whether C-Reactive Protein can be used routinely in patients as a risk factor for., atherosclerosis is still a matter of debate although many trials have proved the association of C-Reactive Protein with atherosclerosis in various vascular beds such as coronary,cerebral and peripheral vascular beds.Most of the studies in relation to C-Reactive Protein has been done in patients with coronary atherosclerosis, more studies are required to prove it’s association in other vascular beds. It can thus be concluded that C-Reactive Protein is a marker of carotid atherosclerosis in patients with dyslipidemia which is an important risk factor for atherosclerosis.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | C-Reactive Protein levels ; carotid atherosclerotic plaques ;dyslipidemic patients. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Feb 2018 01:43 |
| Last Modified: | 14 Feb 2018 03:15 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5696 |
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