Association of Elevated Fibrinogen and C-reactive Protein Levels with Carotid Lesions in Patients with Newly Diagnosed Hypertension or Type II Diabetes

Background: Inflammation may be important for accelerated progression of atherosclerosis in patients with hypertension or diabetes, but few studies included subjects with early stages of atherosclerosis such as those with asymptomatic carotid lesions.

Methods: We studied 100 patients with newly diagnosed hypertension and another 100 patients with newly diagnosed type II diabetes to evaluate in such groups the association of two markers of inflammation, fibrinogen and C-reactive protein (CRP), with carotid atherosclerosis, beyond traditional cardiovascular risk factors (e.g., older age, male gender, obesity, smoking, family history of CAD, dyslipidemia).

Results: We found positive correlation between the extent of carotid intima-media thickness (IMT) and levels of CRP (p <0.0001 in both groups) and fibrinogen (p <0.0001 in diabetics only). By multivariate analysis we searched, among all evaluated cardiovascular risk factors including markers of inflammation, for independent variables associated with carotid lesions (IMT >1.5 mm) and found in patients with hypertension a predictive role for elevated levels of CRP (OR 4.1, 95% CI 1.1-16.4, p = 0.0429), whereas in diabetics we found a predictive role for elevated levels of fibrinogen (OR 6.0, 95% CI 2.0-18.1, p = 0.0014) and CRP (OR 4.4, 95% CI 1.4-13.7, p = 0.0096).

Conclusions: Recent studies have addressed the importance of therapeutic modulation of CRP and fibrinogen levels in high-risk patients for cardiovascular prevention; however, beyond the utility of these markers in the prediction of carotid lesions in subjects with newly diagnosed hypertension or diabetes, further studies are needed to evaluate the therapeutic implications in such patients.