Utility of measuring C-reactive protein for prediction of in-hospital events in patients with acute aortic dissection.

Controlling blood pressure is essential for prevention of events after acute aortic dissection (AAD). However, in some instances a cardiac event occurs despite controlled blood pressure, and its prediction is difficult. We continuously monitored C-reactive protein (CRP) in patients receiving medical treatment for AAD and retrospectively examined the utility of CRP measurement for prediction of in-hospital events. Five hundred and eight patients were diagnosed as having AAD between 1993 and 2009, 240 of whom underwent antihypertensive medical therapy. These subjects were 156 males and 84 females, average age 67.4 years, with 68 cases of Stanford type A and 172 cases of Stanford type B. C-reactive protein was measured in all patients daily until a peak; subsequently, CRP was measured 2-3 times per week following the peak until discharge. In the event-free group CRP demonstrated a peak on the 4th day after the onset (average 13.7 mg/dl), then gradually decreased to an average of 4.6 mg/dl 4 weeks later, displaying a "gradual decay" pattern. Despite controlled systolic arterial pressure of approximately 120 mmHg, 7 of 68 Stanford A cases (10.3 %) and 8 of 172 Stanford B cases (4.7 %) developed cardiovascular events. The group characterized by events exhibited a CRP pattern distinct from that of the event-free group, i.e., prolonged elevation and/or re-elevation. We demonstrated that the CRP pattern could provide information regarding prediction of cardiovascular events. Prolonged elevation or re-elevation of CRP may indicate the necessity of (1) application of computed tomography or magnetic resonance imaging, (2) more rigorous blood pressure management, or (3) early surgical intervention.

A case-control study found that low albumin and smoking were associated with aortic dissection.

OBJECTIVE: Hypertension is a risk factor for aortic dissection. Besides hypertension, associated factors for incidence of aortic dissection are not clear. The aim of this study was to examine whether other factors exist by an epidemiologic case-control approach. STUDY DESIGN AND SETTING: 240 consecutive cases suffering from acute aortic dissection were hospitalized in our university from 1989 to 2000. Blood chemistries and other information obtained immediately after admissions for the first attack were available in 226 patients. A case-control approach was performed by frequency matching age, sex, and history of hypertension in the remaining 226 cases with those of 226 healthy controls drawn from a similar geographic catchment area and all observed in 1989. RESULTS: The mean albumin (3.6 +/- 0.5 vs. 4.3 +/- 0.2 g/dL: P<.001) level of cases was significantly lower than that of controls (odds ratio: 0.004 per g/dL). The frequency with which cases of current smokers was significantly higher than that of controls (odds ratio: 3.475). The above parameters of cases compared with controls were statistically significant after adjustments for age, sex, and history of hypertension. CONCLUSION: Low albumin levels and smoking in addition to hypertension are significantly associated with aortic dissection.

Association of plasminogen activator inhibitor-1 with insulin resistance in Japan where obesity is rare.

The association between plasminogen activator inhibitor-1 (PAI-1) and insulin resistance is established in western countries. The major component of this association is obesity. Accordingly, we examined this association in Japan where the prevalence of obesity is low. Data for fasting PAI-1 levels of 404 subjects were obtained from a general population in a farming area. We measured body mass index (BMI), systolic and diastolic blood pressure, high-density lipoprotein (HDL)-cholesterol, triglycerides, fasting plasma glucose (FPG), insulin, creatinine, and uric acid. The use of alcohol was ascertained by a questionnaire. The formula for the homeostasis model assessment (HOMA) score was used as an index of insulin resistance. Uni- and multivariate analyses were applied for the determinants of plasma PAI-1. Age and sex did not affect plasma PAI-1. The average BMI was 23.0 +/- 3.2 kg/m(2). Thus, most of the subjects were not obese. Because, even in this population, BMI (P <.001) was the strongest determinant for PAI-1 after univariate analysis, we performed multiple linear regression analyses after adjustment for BMI. The significance of triglycerides, FPG, insulin, and the HOMA score still remained. PAI-1 levels were linearly related to the HOMA score. From the subanalysis of the non-obese subjects (BMI < 25; n = 298), waist-hip ratio, triglycerides, FPG, and HOMA scores were significant determinants of PAI-1. This is the first demonstration that increased PAI-1 levels were significantly related to insulin resistance in a Japanese general population. PAI-1 levels are associated with insulin resistance, irrespective of obesity.