Atherosclerosis 207 (2009) 591–596 Contents lists available at ScienceDirect Atherosclerosis journal homepage: www.elsevier.com/locate/atherosclerosis Impact of the metabolic syndrome on high-sensitivity C reactive protein levels in patients with acute coronary syndrome Teoman Kilic a,∗ , Hani Jneid b , Ertan Ural a , Gokhan Oner a , Tayfun Sahin a , Guliz Kozdag a , Goksel Kahraman a , Dilek Ural a,c a Kocaeli University Medical Faculty, Department of Cardiology, Kocaeli, Turkey b Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA c Clinical Research Unit, Kocaeli University, Kocaeli, Turkey article info Article history: Received 9 November 2008 Received in revised form 27 May 2009 Accepted 28 May 2009 Available online 11 June 2009 Keywords: Metabolic syndrome Acute coronary syndrome High-sensitivity C reactive protein Inflammatory response abstract Objective: Underlying predisposition for a heightened inflammatory response is postulated as one of the mechanisms for elevated high-sensitivity C reactive protein (hs-CRP) levels in patients with acute coronary syndrome (ACS). It is unclear whether metabolic syndrome (MetS) may cause a predisposition for heightened hs-CRP response in patients with ACS. The aim of this study is to investigate the interaction between hs-CRP levels and presence of MetS in patients with and without ACS. Methods: Two hundred and seventy-three consecutive patients presenting with a first ACS event and 261 MetS patients without any ACS event were included to the study. The study participants were divided into three groups as MetS (+) ACS (-)[n = 261], MetS (-) ACS (+) [n =110], and MetS (+) ACS (+) [n = 163]. Median levels of hs-CRP were compared between and within the three groups. Results: Hs-CRP levels were lowest in MetS (+) ACS (-) subjects and highest in MetS (+) ACS (+) patients. Factors associated with hs-CRP levels were troponin elevation, presence of ACS, body mass index (BMI), and presence of MetS (R 2 = 0.26, p < 0.01). Predictors of elevated hs-CRP levels (>0.3 mg/dl) were the pres- ence of ACS (OR = 3.6, 95% CI = 1.9–6.5, p < 0.01), presence of MetS (OR = 2.1, 95% CI = 1.0–4.0, p = 0.02), troponin elevation (OR = 5.7, 95% CI = 2.8–11.5, p < 0.01) and BMI (OR = 1.1, 95% CI = 1.0–1.1, p < 0.01). Conclusions: The presence of MetS had an impact on the increase in hs-CRP levels observed with an ACS event in the study population. These findings suggested that a heightened baseline inflammatory status of MetS may predispose ACS patients to an augmented hs-CRP response. © 2009 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The recognition of inflammation as a central phenomenon in athero-thrombosis has forced clinicians to evaluate the relation- ship between circulating inflammatory biomarkers, cardiovascular risk, and the progression of atherosclerosis [1–4]. High-sensitivity C reactive protein (hs-CRP) has emerged as a robust inflam- matory marker and a reliable predictor of future cardiovascular events in healthy individuals, patients with metabolic syndrome (MetS) and in those with acute coronary syndromes (ACS) [2,5–7]. A clear relationship between hs-CRP and future adverse events was described in patients with ACS; however, the source and mech- anisms of generation of elevated hs-CRP levels in ACS patients ∗ Corresponding author at: Kocaeli University Medical Faculty, Cardiology Depart- ment, Umuttepe Yerleskesi Eski Istanbul Yolu 10 km, 41380 Umuttepe/Izmit, Turkey. Tel.: +90 262 3037335; fax: +90 262 3038483. E-mail addresses: kilicteoman@yahoo.com, teoman.kilic@kocaeli.edu.tr (T. Kilic). remain elusive [2,6–9]. Myocardial necrosis following AMI, reper- fusion therapy, extent of the atherosclerosis, inflammatory burden of coronary vascular bed, plaque rupture, thrombosis phenomena and concomitant coronary risk factors with ACS were potentially accused mechanisms [2,10,11]. It has also been concluded that the magnitude of hs-CRP response may vary according to both clinical condition and from person to person but the highest CRP values dur- ing ACS are likely to be observed in patients with already-elevated CRP values at baseline. Emerging work also shows the association of such genetic variants in CRP not only to CRP levels, but also to variation of CRP levels in the acute phase response [2,8,9]. In this regard, whether some ACS patients are predisposed to develop an enhanced inflammatory response and whether this ability is acquired or genetic remain matters of constant debate [8,9]. A number of studies in patients with ACS showed a strong positive correlation between the baseline levels of hs-CRP and its augmentation by various inflammatory stimuli. These results demonstrated that patients with elevated baseline hs-CRP values have an enhanced augmentation of this biomarker in response to different inflammatory factors [11–13]. 0021-9150/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.atherosclerosis.2009.05.035