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Lifetime Smoking Exposure Affects the Association of C-Reactive Protein with Cardiovascular Disease Risk Factors and Subclinical Disease in Healthy Elderly Subjects
Abstract
Abstract Blood levels of C-reactive protein (CRP), a marker of inflammation, are related to cardiovascular disease risk. To determine cross-sectional correlates in the elderly, we measured CRP in 400 men and women older than 65 years and free of clinical cardiovascular disease at baseline as part of the Cardiovascular Health Study. Only 2% of the values were greater than 10 mg/L, the cut-point usually used to identify inflammation. CRP levels appeared tightly regulated, since there were strong bivariate correlations between CRP and the following: inflammation-sensitive proteins such as fibrinogen ( r =.52); measures of fibrinolysis such as plasmin-antiplasmin complex ( r =.23); pack-years of smoking ( r =.30); and body mass index ( r =.24; all P values≤.001). The association with pack-years was independent of the length of time since cessation of smoking. CRP levels were also associated with coagulation factors VIIc, IXc, and Xc; HDL cholesterol (negative) and triglyceride; diabetes status; diuretic use; ECG abnormalities; and level of exercise. Because of effect modification, two multiple linear regression prediction models were developed for CRP, one each for never smokers and ever smokers. An a priori physiologic model was used to guide these analyses, which disallowed the use of other inflammation-sensitive variables such as fibrinogen. In never smokers, the independent predictors were body mass index (+), diabetes status (+), plasmin-antiplasmin complex (+), and the presence of ECG abnormalities (+); this model predicted 15% of the CRP population variance. In ever smokers, the predictors were body mass index (+), plasmin-antiplasmin complex (+), pack-years of smoking (+), HDL cholesterol (−), and ankle-arm blood pressure index (−); this model predicted 42% of the population variance. We conclude that levels of CRP in the healthy elderly are tightly regulated and reflect lifetime exposure to smoking as well as level of obesity, ongoing level of fibrinolysis, diabetes status, and level of subclinical atherothrombotic disease. Moreover, exposure to smoking affects the relation of CRP to these other factors.
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“Smoking is also associated with a systemic inflammatory response and can increase spontaneous preterm birth through that pathway.64, 65”
From Epidemiology and causes of preterm birth (2008) · cites this paper as [64]
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Chronic Subclinical Inflammation as Part of the Insulin Resistance Syndrome
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Metadata
- Authors
- Tracy, R. P., Psaty, B. M., Macy, E., Bovill, E. G., Cushman, M., Cornell, E. S., & Kuller, L. H.
- Affiliations
- University of Vermont (US)
- Venue
- Arteriosclerosis, Thrombosis, and Vascular Biology
- Published
- 1997-10
- Volume
- 17
- Issue
- 10
- Pages
- 2167-2176
- ISSN
- 1079-5642 (ISSN-L)
- 1524-4636
- OpenAlex
- W2070195189
- Cited by
- 539
- References
- 56
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 2 · 2022: 9 · 2021: 6 · 2020: 15 · 2019: 12 · 2018: 10 · 2017: 14 · 2016: 14 · 2015: 14 · 2014: 19 · 2013: 15 · 2012: 24
- FWCI
- 13.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arteriosclerosis Thrombosis and Vascular Biology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wake Forest University
- Johns Hopkins University
- National Institutes of Health (n01hc085079-024, n01hc085080-026)
- Genentech
- University of California, Davis
- Claude Pepper Older Americans Independence Center, Wake Forest School of Medicine
- National Heart, Lung, and Blood Institute (R01HL046696, R01-HL-46696, N01HC85080, N01-HC85079)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Keywords
- C-reactive protein, smoking, pack-years, cardiovascular risk factors, inflammation, fibrinogen, plasmin-antiplasmin complex, fibrinolysis, body mass index, obesity, diabetes mellitus, HDL cholesterol, triglycerides, electrocardiographic abnormalities, older adults, Cardiovascular Health Study, effect modification
- MeSH terms
- Aged, C-Reactive Protein, Cardiovascular Diseases, Female, Humans, Male, Risk Factors, Smoking, Body Mass Index, Multivariate Analysis
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