CRP may guide vascular risk assessment in obese

By Eleanor McDermid

Low C-reactive protein (CRP) levels may identify obese people who are unlikely to develop cardiovascular complications over subsequent years, show data from the EPIC study.

The researchers identified 663 people from the EPIC (European Prospective Investigation of Cancer)-Norfolk cohort who had abdominal obesity yet were metabolically healthy, with normal insulin sensitivity, blood pressure and lipid profiles.

Among these people, the 337 with CRP levels of at least 2 mg/L tended to have an increased rate of coronary heart disease (CHD) events relative to the 326 with lower levels, at an adjusted hazard ratio of 1.59 (p=0.066) during an average 10.9 years of follow-up.

"More important, we observed that metabolically healthy obese persons with low CRP levels had a CHD risk similar to that of healthy nonobese persons", say Diederik van Wijk (Academic Medical Center, Amsterdam, the Netherlands) and study co-authors.

The cohort contained 2610 metabolically healthy nonobese people with CRP levels below 2 mg/L, and their risk of CHD events was a nonsignificant 9% lower than that of metabolically healthy obese people with low CRP, while the risk among 925 metabolically healthy nonobese people with higher CRP levels was a nonsignificant 22% higher.

The researchers note that previous studies have offered conflicting evidence as to whether metabolically healthy obese people have an increased cardiovascular risk.

The current findings "suggest that CRP could help identify those metabolically healthy obese persons who are at low CHD risk", they write in the Journal of the American Heart Association.

They add that a previous study "suggested that metabolically healthy obese persons might have decreased cardiovascular risk compared with their metabolically unhealthy peers because the metabolically healthy group is usually more physically fit."

As anticipated, abdominally obese people with an unhealthy metabolic profile had a significantly increased risk of CHD events, by 1.88- and 2.29-fold for those with low and higher CRP levels, respectively, relative to metabolically healthy obese people with low CRP.

The team concludes that CRP may aid prognosis in obese people, "although the presence or absence of cardiometabolic risk factors may influence the predictive value of CRP in abdominally obese persons".

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