Background: Elevated levels of C-reactive protein (CRP) are associated with poor cardiovascular outcomes, even after accounting for traditional cardiovascular risk factors. We sought to analyze the relationship between levels of CRP and coronary plaque subtypes as assessed by coronary computed tomography angiography.
Methods and results: We evaluated 1004 asymptomatic South Korean subjects (mean age, 49±9.3 years) who underwent coronary computed tomography angiography as part of a health screening evaluation. We examined the association between increasing CRP levels and plaque subtypes using multivariable linear and logistic regression analysis. Coronary plaque was observed in 211 of 1004 individuals (21%). Subjects with high CRP (≥2 mg/L) had an increased prevalence of any plaque type (30.7% versus 16.7% P<0.001) and mixed calcified arterial plaque (MCAP) (19.3% versus 6.3% P<0.001) as compared with subjects with low-normal CRP. Multivariable logistic regression analysis demonstrated that elevated CRP predicted the presence of any MCAP (high versus low-normal CRP group; odds ratio, 2.81; 95% confidence interval, 1.62 to 4.89). When examining the multivariable logistic regression analysis between the presence of ≥2 plaques and CRP, subjects with high CRP were more likely to have MCAP than those with low-normal CRP levels (odds ratio, 3.78; 95% confidence interval, 1.49 to 9.55).
Conclusions: Elevated levels of CRP are associated with an increased prevalence of MCAP as assessed by coronary computed tomography angiography. Longitudinal studies will determine if the excess risk observed in persons with elevated CRP may be mediated, at least in part, by an increased burden of MCAP.