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Ciccarone Articles

Ciccarone Center Research



Landmark Articles

Use of high sensitivity C-reactive protein for risk assessment.
By: Martin SS, Johnson AE, Blumenthal RS.
We present a state-of-the-art review of the use of blood-based biomarkers to refine cardiovascular risk prediction.
ASK NOT what CRP can do for you.
By: Blumenthal RS, Ndumele CE, Martin SS.

This editorial examines the extent to which measurements of vascular inflammation can improve cardiovascular risk prediction.

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Inflammation and CAD: Use of hs-C-Reactive protein as a diagnostic and prognostic tool.
By: Yousuf O, Martin SS, Whelton SP, Blumenthal RS.
High-sensitivity C-reactive protein and cardiovascular disease: A resolute belief or an elusive link?
By: Yousuf O, Mohanty BD, Martin SS, Joshi PH, Blaha MJ, Nasir K, Blumenthal RS, Budoff MJ.
Although high-sensitivity C-reactive protein (hsCRP) is involved in the immunologic process that triggers vascular remodeling and plaque deposition and is associated with increased cardiovascular disease (CVD) risk, definitive randomized evidence for its role as a causative factor in atherothrombosis is lacking. This article reviews four distinct points from the literature to better understand the current state and application of hsCRP in clinical practice, and we highlight recommendations from societies and important considerations when using hsCRP to guide treatment decisions in the primary prevention setting.
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C-reactive protein level and the incidence of eligibility for statin therapy: the multi-ethnic study of atherosclerosis.
By: Mann DM, Shimbo D, Cushman M, Lakoski S, Greenland P, Blumenthal RS, Michos ED, Lloyd-Jones DM, Muntner P.
Findings from this study suggest that many patients with an elevated hsCRP level may not receive the benefits of statins if hsCRP is not incorporated into the NCEP screening strategy.
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Relation of uric acid to serum levels of high-sensitivity C-reactive protein, triglycerides, and high-density lipoprotein cholesterol and to hepatic steatosis.
By: Keenan T, Blaha MJ, Nasir K, Silverman MG, Tota-Maharaj R, Carvalho JA, Conceição RD, Blumenthal RS, Santos RD.
High uric acid levels were associated with increased triglycerides, high-density lipoprotein cholesterol, and hepatic steatosis, independent of metabolic syndrome and obesity, and with increased hsCRP independently of metabolic syndrome.
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Use of high-sensitivity C-reactive protein for risk assessment.
By: Graham G, Ketlogetswe KS, Campbell CY, Musunuru K, Mora S, Blumenthal RS.
Response to letter regarding article, "combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death".
By: Wu KC, Gerstenblith G, Marine JE, Dalal D, Cheng A, Lima JA, Tomaselli GF, Weiss RG, Guallar E, Marbán E.


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Associations of salivary cortisol levels with inflammatory markers: the Multi-Ethnic Study of Atherosclerosis.
By: DeSantis AS, DiezRoux AV, Hajat A, Aiello AE, Golden SH, Jenny NS, Seeman TE, Shea S.

Socioeconomic and psychosocial factors have been found to be associated with systemic inflammation. Although stress is often proposed as a contributor to these associations, no population studies have investigated the links between inflammation and biomarkers of stress. The current study examines associations between daily cortisol profiles and inflammatory markers interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor (TNF-a) in a population-based sample of 869 adults with repeat measures of cortisol over multiple days. Persons with higher levels of IL-6 had a less pronounced cortisol awakening response, a less steep daily decline, and higher cortisol area under the curve for the day with associations persisting after controls for risk factors and other cytokines. Persons with higher levels of TNF-a had lower cortisol levels upon waking, and flatter daily decline, although associations with decline were attenuated when controlling for inflammatory risk factors. Higher levels of IL-10 were associated with marginally flatter daily cortisol decline (p<.10). This study is the first to identify associations of basal cortisol activity and inflammatory markers in a population based sample. Findings are consistent with the possibility that HPA axis activity may mediate associations between psychosocial stressors and inflammatory processes. Additional prospective data are necessary to clarify the directionality of associations between cortisol and inflammatory markers.

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Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events.
By: Rana JS, Gransar H, Wong ND, Shaw L, Pencina M, Nasir K, Rozanski A, Hayes SW, Thomson LE, Friedman JD, Min JK, Berman DS.
In this study of asymptomatic subjects without known CVD, the addition of CAC but not biomarkers substantially improved risk reclassification for future CVD events beyond traditional risk factors.
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