Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000200006
Jornal Vascular Brasileiro
Original Article

Proteína C reativa e instabilidade clínica na doença obstrutiva de artérias carótidas

C-reactive protein and clinical instability in carotid artery obstructive disease

Daniele de Oliveira Silva; Luciano Cabral Albuquerque; Luciane Barreneche Narvaes; Marco Antônio Goldani; Giuliano Chagas Pereira

http://dx.doi.org/10.1590/S1677-54492007000200006 J Vasc Bras, vol.6, n2, p.124-129, 2007
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Resumo

CONTEXTO: A atividade inflamatória na aterosclerose vem sendo exaustivamente estudada; entretanto, a relevância da Proteína C Reativa como marcador de instabilidade clínica, na doença obstrutiva de artérias carótidas ainda não encontra-se bem estabelecido OBJETIVO: Identificar se os níveis séricos de proteína C reativa ultra-sensível se associam com a apresentação clínica (estável versus instável) da doença obstrutiva grave das artérias carótidas. MÉTODO: Foram estudados 70 pacientes consecutivos com indicação de endarterectomia de carótida pelos critérios dos ensaios NASCET ou ACST, com diferentes tipos de apresentação clínica: grupo 1- assintomáticos ou com sintomas hemisféricos com mais de 90 dias; grupo 2 - com sintomas hemisféricos com menos de 90 dias. Amostras de sangue de cada paciente foram obtidas por punção venosa periférica; a proteína C reativa ultra-sensível foi dosada por nefelometria e a comparação entre os grupos foi realizada através do teste de t de Student, considerando-se significativo o valor de p < 0,05. RESULTADOS: o quadro clínico neurológico foi considerado estável em 28 (40%) pacientes, enquanto que 42 (60%) dos casos foram considerados instáveis. Os valores de proteína C reativa ultra-sensível foram significativamente maiores nos pacientes clinicamente instáveis, quando comparados aos casos estáveis neurologicamente (1,54±1,7 versus 0,67±0,8 mg/dL, respectivamente; p = 0,006). Não houve diferença nos níveis de proteína C reativa ultra-sensível quando comparados os percentuais de estenose angiográfica. CONCLUSÕES: A constatação de que níveis elevados de proteína C reativa ultra-sensível correlacionam-se com instabilidade da placa de carótidas, possivelmente antevendo eventos clínicos, poderá contribuir para uma redefinição dos critérios de tratamento cirúrgico da doença cerebrovascular.

Palavras-chave

Proteína C reativa, carótida, aterosclerose, inflamação

Abstract

BACKGROUND: Inflammatory activity in atherosclerosis has been exhaustively studied; however, the relevance of C-reactive protein as a marker of clinical instability in carotid artery obstructive disease has not been well established yet. OBJECTIVE: To identify whether high-sensitivity C-reactive protein serum levels are associated with clinical presentation (stable vs. unstable) of carotid artery severe obstructive disease. METHODS: Seventy consecutive patients underwent carotid endarterectomy based on NASCET or ACST criteria, and were classified according to clinical presentation: group 1 - asymptomatic or with hemispheric symptoms for more than 90 days; group 2 - with hemispheric symptoms for less than 90 days. Blood samples were collected by peripheral vein puncture; high-sensitivity C-reactive protein was dosed by nephelometry and comparison between groups was performed using Student's t test; p < 0.05 was considered significant. RESULTS: Neurological clinical status was considered stable in 28 (40%) patients, whereas 42 (60%) cases were considered unstable. High-sensitivity C-reactive protein levels were significantly higher in clinically unstable patients, when compared with neurologically stable cases (1.54±1.7 vs. 0.67±0.8 mg/dL, respectively; p = 0.006). There was no difference in high-sensitivity C-reactive protein levels, when compared with percentages of angiographic stenosis. CONCLUSIONS: The fact that high levels of high-sensitivity C-reactive protein are associated with unstable carotid plaque, possibly anticipating clinical events, could contribute to redefining indications for cerebrovascular interventions.

Keywords

C-reactive protein, carotid artery, atherosclerosis, inflammation

References

Jialal I, Devaraj S, Venugopal SK. C-reactive protein: risk marker or mediator in atherosclerosis?. Hypertension. 2004;44:6-11.

Koenig W. Predicting risk and treatment benefit in atherosclerosis: the role of C-reactive protein. Int J Cardiol. 2005;98:199-206.

Alvarez Garcia B, Ruiz C, Chacon P, Sabin JA, Matas M. High-sensitivity C-reactive protein in high-grade carotid stenosis: risk marker for unstable carotid plaque. J Vasc Surg. 2003;38:1018-24.

Barnett HJ, Taylor DW, Eliasziw M. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998;339:1415-25.

Halliday A, Mansfield A, Marro J. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet. 2004;363:1491-502.

Whicher JT, Ritchie RF, Johnson AM. New international reference preparation for proteins in human serum (RPPHS). Clin Chem. 1994;40:934-8.

Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ. Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol. 2005;46:937-54.

Rohde LE, Lee RT. Pathophysiology of atherosclerotic plaque development and rupture: an overview. Semin Vasc Med. 2003;3:347-54.

Ballantyne CM, Nambi V. Markers of inflammation and their clinical significance. Atheroscler Suppl. 2005;6:21-9.

Morrow DA, Rifai N, Antman EM. C-reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes: a TIMI 11A substudy. Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 1998;31:1460-5.

Heeschen C, Hamm CW, Bruemmer J, Simoons ML. Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis. CAPTURE investigators. Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial. J Am Coll Cardiol. 2000;35:1535-42.

Ridker PM, Rifai N, Pfeffer MA. Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels: Cholesterol and Recurrent Events (CARE) Investigators. Circulation. 1998;98:839-44.

Retterstol L, Eikvar L, Bohn M, Bakken A, Erikssen J, Berg K. C-reactive protein predicts death in patients with previous premature myocardial infarction - a 10 year follow-up study. Atherosclerosis. 2002;160:433-40.

Tomoda H, Aoki N. Prognostic value of C-reactive protein levels within six hours after the onset of acute myocardial infarction. Am Heart J. 2000;140:324-8.

Albert CM, Ma J, Rifai N, Stampfer MJ, Ridker PM. Prospective study of C-reactive protein, homocysteine and plasma lipid levels as predictors of sudden cardiac death. Circulation. 2002;105:2595-9.

Rost NS, Wolf PA, Kase CS. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke. 2001;32:2575-9.

Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Plasma concentration of C-reactive protein and risk of developing peripheral vascular disease. Circulation. 1998;97:425-8.

Wang TJ, Nam BH, Wilson PW. Association of C-reactive protein with carotid atherosclerosis in men and women: the Framingham Heart Study. Arterioscler Thromb Vasc Biol. 2002;22:1662-7.

Cao JJ, Thach C, Manolio TA. C-reactive protein, carotid intima-media thickness, and incidence of ischemic stroke in the elderly: the Cardiovascular Health Study. Circulation. 2003;108:166-70.

Magyar MT, Szikszai Z, Balla J. Early-onset carotid atherosclerosis in associated with increased intima-media thickness and elevated serum levels of inflammatory markers. Stroke. 2003;34:58-63.

Kocer A, Canbulat C, Gozke E, Ilhan A. C-reactive protein is an indicator for fatal outcomes in first-time stroke patients. Med Sci Monit. 2005;11:CR540-4.

Arenillas JF, Alvarez-Sabin J, Molina CA. C-reactive protein predicts further ischemic events in first-ever transient ischemic attack or stroke patients with intracranial large-artery occlusive disease. Stroke. 2003;34:2463-8.

Hoshi T, Kitagawa K, Yamagami H, Furukado S, Hougaku H, Hori M. Relations of serum high-sensitivity C-reactive protein and interleukin-6 levels with silent brain infarction. Stroke. 2005;36:768-72.

Pearson TA, Mensah GA, Alexander RW. Markers of inflammation and cardiovascular disease: application to clinical and public health practice. A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107:499-511.

Bos MJ, Schipper CM, Koudstaal PJ, Witteman JC, Hofman A, Breteler MM. High serum C-reactive protein level is not an independent predictor for stroke: the Study. Circulation. 2006;114:1591-8.

Di Napoli M, Schwaninger M, Cappelli R. Evaluation of C-reactive protein measurement for assessing the risk and prognosis in ischemic stroke: a statement for health care professionals from the CRP Pooling Project Members. Stroke. 2005;36:1316-29.

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