Impact of the metabolic syndrome on high-sensitivity C reactive protein levels in patients with acute coronary syndrome

Objective: Underlying predisposition for a heightened inflammatory response is postulated as one of the mechanisms for elevated high-sensitivity C reactive protein (hs-CRP) levels in patients with acute coronary syndrome (ACS). It is unclear whether metabolic syndrome (MetS) may cause a predisposition for heightened hs-CRP response in patients with ACS. The aim of this study is to investigate the interaction between hs-CRP levels and presence of MetS in patients with and without ACS. Methods: Two hundred and seventy-three consecutive patients presenting with a first ACS event and 261 MetS patients without any ACS event were included to the study. The study participants were divided into three groups as MetS (+) ACS (-) [n = 261], MetS (-) ACS (+) [n = 110], and MetS (+) ACS (+) [n = 163]. Median levels of hs-CRP were compared between and within the three groups. Results: Hs-CRP levels were lowest in MetS (+) ACS (-) subjects and highest in MetS (+) ACS (+) patients. Factors associated with hs-CRP levels were troponin elevation, presence of ACS, body mass index (BMI), and presence of MetS (R² = 0.26, p < 0.01). Predictors of elevated hs-CRP levels (>0.3 mg/dl) were the presence of ACS (OR = 3.6, 95% CI = 1.9-6.5, p < 0.01), presence of MetS (OR = 2.1, 95% CI = 1.0-4.0, p = 0.02), troponin elevation (OR = 5.7, 95% CI = 2.8-11.5, p < 0.01) and BMI (OR = 1.1, 95% CI = 1.0-1.1, p < 0.01). Conclusions: The presence of MetS had an impact on the increase in hs-CRP levels observed with an ACS event in the study population. These findings suggested that a heightened baseline inflammatory status of MetS may predispose ACS patients to an augmented hs-CRP response.