C-reactive protein and subclinical cardiovascular disease among African-Americans: (the Jackson Heart Study).

OBJECTIVE: Systemic inflammation has been implicated as an early marker for subclinical cardiovascular disease; however, findings have been inconsistent in the African-American population. METHODS: We examined the relation of C-reactive protein (CRP) to subclinical disease in African-American participants of the Jackson Heart Study first examination. Subclinical disease evaluated included aortic valve calcification (AVC), carotid intima-medial thickness (IMT) and peripheral arterial disease (PAD). We assessed the relation of CRP to subclinical disease, adjusting for age, BMI, sex, SBP and DBP, diabetes, total/high-density lipoprotein cholesterol, triglycerides, smoking, antihypertensive therapy, lipid-lowering therapy and hormone replacement therapy. RESULTS: In the study population approximately, 5.1% of participants had AVC and 6.7% had PAD. In the age-adjusted and sex-adjusted model, CRP was significantly related to AVC (P = 0.02) and carotid IMT (P = 0.02). However, in the multivariable-adjusted logistic regression analysis, CRP was significantly related to AVC (P = 0.02) and to PAD (P = 0.04) but not to carotid IMT (P = 0.18). CONCLUSION: We describe significant associations between CRP and AVC and PAD in a population-based cohort of African-Americans.

Medical therapy for systemic lupus erythematosus.

The many clinical manifestations of systemic lupus erythematosus (SLE) result in the involvement of many specialties of medicine in its treatment. An understanding of the indications, potential side-effects, and toxicity monitoring required of common agents used as medical therapy in SLE disease management is important for all providers who care for lupus patients. Pharmacological therapy is based on the type and severity of clinical manifestation and involves four primary classes of drugs: non-steroidal antiinflammatory drugs, antimalarials, corticosteroids, and immunosuppressives/cytoxics.

The relation of C--reactive protein to chronic kidney disease in African Americans: the Jackson Heart Study.

BACKGROUND: African Americans have an increased incidence and worse prognosis with chronic kidney disease (CKD--estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2) than their counterparts of European-descent. Inflammation has been related to renal disease in non-Hispanic whites, but there are limited data on the role of inflammation in renal dysfunction in African Americans in the community. METHODS: We examined the cross-sectional relation of log transformed C-reactive protein (CRP) to renal function (eGFR by Modification of Diet and Renal Disease equation) in African American participants of the community-based Jackson Heart Study's first examination (2000 to 2004). We conducted multivariable linear regression relating CRP to eGFR adjusting for age, sex, body mass index, systolic and diastolic blood pressure, diabetes, total/HDL cholesterol, triglycerides, smoking, antihypertensive therapy, lipid lowering therapy, hormone replacement therapy, and prevalent cardiovascular disease events. In a secondary analysis we assessed the association of CRP with albuminuria (defined as albumin-to-creatinine ratio > 30 mg/g). RESULTS: Participants (n = 4320, 63.2% women) had a mean age +/- SD of 54.0 +/- 12.8 years. The prevalence of CKD was 5.2% (n = 228 cases). In multivariable regression, CRP concentrations were higher in those with CKD compared to those without CKD (mean CRP 3.2 +/- 1.1 mg/L vs. 2.4 +/- 1.0 mg/L, respectively p < 0.0001). CRP was significantly associated with albuminuria in sex and age adjusted model however not in the multivariable adjusted model (p > 0.05). CONCLUSION: CRP was associated with CKD however not albuminuria in multivariable-adjusted analyses. The study of inflammation in the progression of renal disease in African Americans merits further investigation.

Epidemiology, heritability, and genetic linkage of C-reactive protein in African Americans (from the Jackson Heart Study).

C-reactive protein (CRP) has been studied largely in white non-Hispanic cohorts. There is limited information on CRP's range of values, heritability, and relation to cardiovascular disease risk factors in African Americans. The aim of this study was to evaluate the distribution, clinical correlates, heritability, and genetic linkage of log-transformed CRP in participants in the middle-aged to elderly African American cohort in the community-based Jackson Heart Study. The distribution and correlates of CRP were analyzed for the entire study cohort who underwent the first examination (2001 to 2004). Heritability was estimated for the family cohort nested within the larger Jackson Heart Study (246 families, n = 1,317). The relation between CRP and cardiovascular disease risk factors was tested with multivariable stepwise regression analyses. Heritability was estimated using a variance-components method. Linkage analysis was performed using the multipoint variance-components approach. The study sample consisted of 4,919 participants (mean age 55 +/- 13 years, 63% women); the median CRP concentration was 2.7 mg/L. In stepwise models, traditional risk factors explained 23.8% of CRP's variability, with body mass index (partial R(2) = 13.6%) explaining 57.1% of the variability of CRP due to traditional risk factors. The heritability of CRP (adjusted for age, gender, and body mass index) was 0.45. The strongest linkage evidence for CRP was observed on chromosome 11 (11p13 to 11p11.2), with a logarithm of odds score of 2.72. In conclusion, in this large population-based cohort of African Americans, circulating CRP concentration was heritable and associated with several traditional cardiovascular risk factors, particularly body mass index.