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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:1986-1991.)
© 1999 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Associations of C-Reactive Protein With Measures of Obesity, Insulin Resistance, and Subclinical Atherosclerosis in Healthy, Middle-Aged Women

A. Elisabeth Hak; Coen D. A. Stehouwer; Michiel L. Bots; Kees H. Polderman; Casper G. Schalkwijk; Iris C. D. Westendorp; Albert Hofman; Jacqueline C. M. Witteman

From the Department of Epidemiology and Biostatistics (A.E.H., M.L.B., I.C.D.W., A.H., J.C.M.W.), Erasmus University Medical School, Rotterdam; the Department of Internal Medicine (C.D.A.S., K.H.P.), University Hospital Vrije Universiteit and Institute for Cardiovascular Research Vrije Universiteit, Amsterdam; the Julius Center for Patient Oriented Research (M.L.B.), University Medical Center Utrecht, Utrecht; and the Department of Clinical Chemistry (C.G.S.), University Hospital Vrije Universiteit and Institute for Cardiovascular Research Vrije Universiteit, Amsterdam, the Netherlands.

Correspondence to J.C.M. Witteman, PhD, Department of Epidemiology and Biostatistics, Erasmus University Medical School, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail witteman{at}epib.fgg.eur.nl

Abstract—Obesity, the insulin resistance syndrome, and atherosclerosis are closely linked and may all be determinants of an increased acute-phase response. In this study, we examined the relationship of C-reactive protein (CRP) with measures of obesity, variables of the insulin resistance syndrome, and intima-media thickness of the common carotid arteries in 186 healthy, middle-aged women selected from the general population. Associations were assessed by regression analysis. CRP was strongly associated with body mass index (BMI) and waist circumference. CRP was also associated with other variables of the insulin resistance syndrome, including blood pressure, insulin, high density lipoprotein cholesterol, triglycerides, apolipoprotein A1 (inversely), plasminogen activator inhibitor-1 antigen, and tissue-type plasminogen activator antigen. Associations between CRP and the variables of the insulin resistance syndrome disappeared after controlling for BMI but remained significant for plasminogen activator inhibitor-1 antigen only. The association of CRP with common carotid artery intima-media thickness was weak and limited to ever-smokers. BMI explained 29.7% of the variance of CRP, whereas common carotid artery intima-media thickness explained only 3.7%. The results of this population-based study indicate that adiposity is strongly associated with CRP in healthy, middle-aged women. In this population, BMI accounted for the relationship between CRP and other variables of the insulin resistance syndrome. Further studies should determine whether losing weight ameliorates the inflammatory state.

Key Words: C-reactive protein • obesity • insulin resistance • carotid artery intima-media thickness • women

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				J. C. Chambers, S. Eda, P. Bassett, Y. Karim, S. G. Thompson, J. R. Gallimore, M. B. Pepys, and J. S. Kooner C-Reactive Protein, Insulin Resistance, Central Obesity, and Coronary Heart Disease Risk in Indian Asians From the United Kingdom Compared With European Whites Circulation, July 10, 2001; 104(2): 145 - 150. [Abstract] [Full Text] [PDF]

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				I. Lemieux, A. Pascot, D. Prud'homme, N. Almeras, P. Bogaty, A. Nadeau, J. Bergeron, and J.-P. Despres Elevated C-Reactive Protein : Another Component of the Atherothrombotic Profile of Abdominal Obesity Arterioscler Thromb Vasc Biol, June 1, 2001; 21(6): 961 - 967. [Abstract] [Full Text] [PDF]

				L. K. Heilbronn, M. Noakes, and P. M. Clifton Energy Restriction and Weight Loss on Very-Low-Fat Diets Reduce C-Reactive Protein Concentrations in Obese, Healthy Women Arterioscler Thromb Vasc Biol, June 1, 2001; 21(6): 968 - 970. [Abstract] [Full Text] [PDF]

				M. Cushman, J. P. Costantino, R. P. Tracy, K. Song, L. Buckley, J. D. Roberts, and D. N. Krag Tamoxifen and Cardiac Risk Factors in Healthy Women : Suggestion of an Anti-inflammatory Effect Arterioscler Thromb Vasc Biol, February 1, 2001; 21(2): 255 - 261. [Abstract] [Full Text] [PDF]

				M. Visser, L. M. Bouter, G. M. McQuillan, M. H. Wener, and T. B. Harris Low-Grade Systemic Inflammation in Overweight Children Pediatrics, January 1, 2001; 107(1): 13e - 13. [Abstract] [Full Text]

				C. J. Packard, D. S.J. O'Reilly, M. J. Caslake, A. D. McMahon, I. Ford, J. Cooney, C. H. Macphee, K. E. Suckling, M. Krishna, F. E. Wilkinson, et al. Lipoprotein-Associated Phospholipase A2 as an Independent Predictor of Coronary Heart Disease N. Engl. J. Med., October 19, 2000; 343(16): 1148 - 1155. [Abstract] [Full Text] [PDF]

				V. A. Fonseca Risk Factors for Coronary Heart Disease in Diabetes Ann Intern Med, July 18, 2000; 133(2): 154 - 156. [Full Text] [PDF]

				A. N. Vgontzas, E. O. Bixler, D. A. Papanicolaou, G. P. Chrousos, B. R. Bistrian, L. Khaodhiar, M. Visser, and T. B. Harris Chronic Systemic Inflammation in Overweight and Obese Adults JAMA, May 3, 2000; 283(17): 2235 - 2236. [Full Text] [PDF]

				T. E. Strandberg and R. S. Tilvis C-Reactive Protein, Cardiovascular Risk Factors, and Mortality in a Prospective Study in the Elderly Arterioscler Thromb Vasc Biol, April 1, 2000; 20(4): 1057 - 1060. [Abstract] [Full Text] [PDF]

				W. L. Roberts, R. Sedrick, L. Moulton, A. Spencer, and N. Rifai Evaluation of Four Automated High-Sensitivity C-Reactive Protein Methods: Implications for Clinical and Epidemiological Applications Clin. Chem., April 1, 2000; 46(4): 461 - 468. [Abstract] [Full Text] [PDF]