Journal of Vascular Surgery
Volume 45, Issue 1 , Pages 2-9 , January 2007

Elevated C-reactive protein levels are associated with postoperative events in patients undergoing lower extremity vein bypass surgery

Presented at The Society for Vascular Surgery, Vascular Annual Meeting, Philadelphia, Pa, June 1 to 4, 2006.

  • Christopher D. Owens, MD

      Affiliations

    • Division of Vascular Surgery, Brigham and Women’s Hospital, Boston, Mass
  • ,
  • Paul M. Ridker, MD

      Affiliations

    • Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, Boston, Mass
  • ,
  • Michael Belkin, MD

      Affiliations

    • Division of Vascular Surgery, Brigham and Women’s Hospital, Boston, Mass
  • ,
  • Allen D. Hamdan, MD

      Affiliations

    • Division of Vascular Surgery at Beth Israel Deaconess Medical Center, Boston, Mass.
  • ,
  • Frank Pomposelli, MD

      Affiliations

    • Division of Vascular Surgery at Beth Israel Deaconess Medical Center, Boston, Mass.
  • ,
  • Frank Logerfo, MD

      Affiliations

    • Division of Vascular Surgery at Beth Israel Deaconess Medical Center, Boston, Mass.
  • ,
  • Mark A. Creager, MD

      Affiliations

    • Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Mass
  • ,
  • Michael S. Conte, MD

      Affiliations

    • Division of Vascular Surgery, Brigham and Women’s Hospital, Boston, Mass
    • Corresponding Author InformationCorrespondence: Michael S. Conte, MD, Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Boston, MA 02115.

Received 29 June 2006 ,Accepted 22 August 2006.

References 

  1. Criqui MH. Peripheral arterial disease—epidemiological aspects. Vasc Med. 2001;6:3–7
  2. Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med. 1992;326:381–386
  3. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340:115–126
  4. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336:973–979
  5. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347:1557–1565
  6. Pai JK, Pischon T, Ma J, Manson JE, Hankinson SE, Joshipura K, et al. Inflammatory markers and the risk of coronary heart disease in men and women. N Engl J Med. 2004;351:2599–2610
  7. Ballantyne CM, Hoogeveen RC, Bang H, Coresh J, Folsom AR, Heiss G, et al. Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident coronary heart disease in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2004;109:837–842
  8. Koenig W, Khuseyinova N, Lowel H, Trischler G, Meisinger C. Lipoprotein-associated phospholipase A2 adds to risk prediction of incident coronary events by C-reactive protein in apparently healthy middle-aged men from the general population: results from the 14-year follow-up of a large cohort from southern Germany. Circulation. 2004;110:1903–1908
  9. Danesh J, Wheeler JG, Hirschfield GM, Eda S, Eiriksdottir G, Rumley A, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004;350:1387–1397
  10. Cushman M, Arnold AM, Psaty BM, Manolio TA, Kuller LH, Burke GL, et al. C-reactive protein and the 10-year incidence of coronary heart disease in older men and women: the cardiovascular health study. Circulation. 2005;112:25–31
  11. Ridker PM. Rosuvastatin in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: rationale and design of the JUPITER trial. Circulation. 2003;108:2292–2297
  12. Nissen SE, Tuzcu EM, Schoenhagen P, Crowe T, Sasiela WJ, Tsai J, et al. Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease. N Engl J Med. 2005;352:29–38
  13. Ridker PM, Cannon CP, Morrow D, Rifai N, Rose LM, McCabe CH, et al. C-reactive protein levels and outcomes after statin therapy. N Engl J Med. 2005;352:20–28
  14. Taylor LM, Edwards JM, Porter JM. Present status of reversed vein bypass grafting: five-year results of a modern series. J Vasc Surg. 1990;11:193–205discussion 205-196
  15. Conte MS, Belkin M, Upchurch GR, Mannick JA, Whittemore AD, Donaldson MC. Impact of increasing comorbidity on infrainguinal reconstruction: a 20-year perspective. Ann Surg. 2001;233:445–452
  16. Cox JL, Chiasson DA, Gotlieb AI. Stranger in a strange land: the pathogenesis of saphenous vein graft stenosis with emphasis on structural and functional differences between veins and arteries. Prog Cardiovasc Dis. 1991;34:45–68
  17. Hoch JR, Stark VK, Hullett DA, Turnipseed WD. Vein graft intimal hyperplasia: leukocytes and cytokine gene expression. Surgery. 1994;116:463–470discussion 470-61
  18. Stark VK, Hoch JR, Warner TF, Hullett DA. Monocyte chemotactic protein-1 expression is associated with the development of vein graft intimal hyperplasia. Arterioscler Thromb Vasc Biol. 1997;17:1614–1621
  19. Zhang L, Peppel K, Brian L, Chien L, Freedman NJ. Vein graft neointimal hyperplasia is exacerbated by tumor necrosis factor receptor-1 signaling in graft-intrinsic cells. Arterioscler Thromb Vasc Biol. 2004;24:2277–2283
  20. Abbruzzese TA, Havens J, Belkin M, Donaldson MC, Whittemore AD, Liao JK, et al. Statin therapy is associated with improved patency of autogenous infrainguinal bypass grafts. J Vasc Surg. 2004;39:1178–1185
  21. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836–843
  22. Koenig W, Sund M, Frohlich M, Fischer HG, Lowel H, Doring A, et al. C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation. 1999;99:237–242
  23. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation. 1998;98:731–733
  24. 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;97:425–428
  25. Ridker PM, Stampfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA. 2001;285:2481–2485
  26. Wildman RP, Muntner P, Chen J, Sutton-Tyrrell K, He J. Relation of inflammation to peripheral arterial disease in the national health and nutrition examination survey, 1999-2002. Am J Cardiol. 2005;96:1579–1583
  27. Beckman JA, Preis O, Ridker PM, Gerhard-Herman M. Comparison of usefulness of inflammatory markers in patients with versus without peripheral arterial disease in predicting adverse cardiovascular outcomes (myocardial infarction, stroke, and death). Am J Cardiol. 2005;96:1374–1378
  28. McDermott MM, Guralnik JM, Corsi A, Albay M, Macchi C, Bandinelli S, et al. Patterns of inflammation associated with peripheral arterial disease: the InCHIANTI study. Am Heart J. 2005;150:276–281
  29. Tzoulaki I, Murray GD, Lee AJ, Rumley A, Lowe GD, Fowkes FG. C-reactive protein, interleukin-6, and soluble adhesion molecules as predictors of progressive peripheral atherosclerosis in the general population: Edinburgh Artery Study. Circulation. 2005;112:976–983
  30. McDermott MM, Greenland P, Green D, Guralnik JM, Criqui MH, Liu K, et al. D-dimer, inflammatory markers, and lower extremity functioning in patients with and without peripheral arterial disease. Circulation. 2003;107:3191–3198
  31. McDermott MM, Guralnik JM, Greenland P, Green D, Liu K, Ridker PM, et al. Inflammatory and thrombotic blood markers and walking-related disability in men and women with and without peripheral arterial disease. J Am Geriatr Soc. 2004;52:1888–1894
  32. Vainas T, Stassen FR, de Graaf R, Twiss EL, Herngreen SB, Welten RJ, et al. C-reactive protein in peripheral arterial disease: relation to severity of the disease and to future cardiovascular events. J Vasc Surg. 2005;42:243–251
  33. Vainas T, Lubbers T, Stassen FR, Herngreen SB, van Dieijen-Visser MP, Bruggeman CA, et al. Serum C-reactive protein level is associated with abdominal aortic aneurysm size and may be produced by aneurysmal tissue. Circulation. 2003;107:1103–1105
  34. Rossi E, Biasucci LM, Citterio F, Pelliccioni S, Monaco C, Ginnetti F, et al. Risk of myocardial infarction and angina in patients with severe peripheral vascular disease: predictive role of C-reactive protein. Circulation. 2002;105:800–803
  35. Doweik L, Maca T, Schillinger M, Budinsky A, Sabeti S, Minar E. Fibrinogen predicts mortality in high risk patients with peripheral artery disease. Eur J Vasc Endovasc Surg. 2003;26:381–386
  36. Wattanakit K, Folsom AR, Selvin E, Weatherley BD, Pankow JS, Brancati FL, et al. Risk factors for peripheral arterial disease incidence in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Atherosclerosis. 2005;180:389–397
  37. Johnson BD, Kip KE, Marroquin OC, Ridker PM, Kelsey SF, Shaw LJ, et al. Serum amyloid A as a predictor of coronary artery disease and cardiovascular outcome in women: the National Heart, Lung, and Blood Institute-Sponsored Women’s Ischemia Syndrome Evaluation (WISE). Circulation. 2004;109:726–732
  38. Rifai N, Joubran R, Yu H, Asmi M, Jouma M. Inflammatory markers in men with angiographically documented coronary heart disease. Clin Chem. 1999;45:1967–1973
  39. Rittersma SZ, de Winter RJ, Koch KT, Schotborgh CE, Bax M, Heyde GS, et al. Preprocedural C-reactive protein is not associated with angiographic restenosis or target lesion revascularization after coronary artery stent placement. Clin Chem. 2004;50:1589–1596
  40. Schillinger M, Exner M, Mlekusch W, Rumpold H, Ahmadi R, Sabeti S, et al. Vascular inflammation and percutaneous transluminal angioplasty of the femoropopliteal artery: association with restenosis. Radiology. 2002;225:21–26
  41. Tschopl M, Tsakiris DA, Marbet GA, Labs KH, Jager K. Role of hemostatic risk factors for restenosis in peripheral arterial occlusive disease after transluminal angioplasty. Arterioscler Thromb Vasc Biol. 1997;17:3208–3214
  42. Schillinger M, Haumer M, Schlerka G, Mlekusch W, Exner M, Ahmadi R, et al. Restenosis after percutaneous transluminal angioplasty in the femoropopliteal segment: the role of inflammation. J Endovasc Ther. 2001;8:477–483
  43. Buffon A, Liuzzo G, Biasucci LM, Pasqualetti P, Ramazzotti V, Rebuzzi AG, et al. Preprocedural serum levels of C-reactive protein predict early complications and late restenosis after coronary angioplasty. J Am Coll Cardiol. 1999;34:1512–1521
  44. Chew DP, Bhatt DL, Robbins MA, Penn MS, Schneider JP, Lauer MS, et al. Incremental prognostic value of elevated baseline C-reactive protein among established markers of risk in percutaneous coronary intervention. Circulation. 2001;104:992–997
  45. Milazzo D, Biasucci LM, Luciani N, Martinelli L, Canosa C, Schiavello R, et al. Elevated levels of C-reactive protein before coronary artery bypass grafting predict recurrence of ischemic events. Am J Cardiol. 1999;84:459–461A9
  46. Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA. 2005;294:326–333
  47. Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868–874
  48. Blake GJ, Ridker PM. Novel clinical markers of vascular wall inflammation. Circ Res. 2001;89:763–771
  49. Schillinger M, Exner M, Mlekusch W, Haumer M, Ahmadi R, Rumpold H, et al. Balloon angioplasty and stent implantation induce a vascular inflammatory reaction. J Endovasc Ther. 2002;9:59–66
  50. Eslami MH, Gangadharan SP, Belkin M, Donaldson MC, Whittemore AD, Conte MS. Monocyte adhesion to human vein grafts: a marker for occult intraoperative injury?. J Vasc Surg. 2001;34:923–929
  51. Jabs WJ, Theissing E, Nitschke M, Bechtel JF, Duchrow M, Mohamed S, et al. Local generation of C-reactive protein in diseased coronary artery venous bypass grafts and normal vascular tissue. Circulation. 2003;108:1428–1431
  52. Pearson TA, Mensah GA, Hong Y, Smith SC. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: application to clinical and public health practice: overview. Circulation. 2004;110:e543–e544
  53. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, Criqui M, et al. 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

 Supported by grant R01 HL 75771 (MAC, MSC), and Clinical Investigator Training Program (C. D. O.).

 Competition of interest: Dr Ridker is listed as a co-inventor on patents held by the Brigham and Women’s Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease.

 CME article

PII: S0741-5214(06)01513-8

doi: 10.1016/j.jvs.2006.08.048

Journal of Vascular Surgery
Volume 45, Issue 1 , Pages 2-9 , January 2007