A comparison of acute phase proteins and traditional risk factors as markers of combined plaque and intima-media thickness and plaque density in carotid and femoral arteries*

Abstract Objectives: to test the hypothesis that some acute phase proteins may be better independent predictors of objective measures of arterial wall impairment than traditional risk factors. Design: cross-sectional study. Materials and Methods: C-reactive protein (CRP), fibrinogen, C3 complement and traditional risk factors were measured in 288 men aged 55-64 years, randomly chosen from the local registry lists. By ultrasound assessment of the bifurcations of carotid and femoral arteries, maximum combined plaque/intima-media thickness (CPIMTmax) and mean plaque density (MPD, in a grey scale from 0 to 255) were also measured. Results: in multivariate analysis only traditional risk factors remained associated with the overall CPIMTmax: smoking ( r = 0.35, p r = 0.23, p = 0.0001), age ( r = 0.22, p = 0.0002), glucose ( r = 0.18, p = 0.002) and systolic blood pressure ( r = 0.13, p = 0.02). However, with regard to carotid disease only, fibrinogen was the strongest covariate of CPIMT ( r = 0.18, p = 0.002). The overall MPD was independently associated with CRP ( r = 0.25, p = 0.0008), physical activity ( r = 0.19, p = 0.009), triglycerides ( r = −0.18, p = 0.02) and body mass index ( r = 0.15, p = 0.04). CRP was mainly associated with femoral MPD, while triglycerides were the major (inverse) covariate of carotid MPD. Conclusions: traditional risk factors are the main determinants of CPIMTmax, although fibrinogen seems to play a role in carotids. CRP was associated with high density femoral plaques. Finally, no acute phase protein was independently associated with low density, potentially vulnerable, plaques. Eur J Vasc Endovasc Surg 26 , 81-87 (2003)