Background and Objectives: Atherosclerosis is now known to be an active process of cell activation, inflammation and thrombosis.¹ To study, the serum hs- CRP level, a biomarker of inflammation in patients with acute coronary syndrome, such studies are sparse in India.

Methods: Patients with  ACS who were fulfilling the inclusion criteria, attending cardiology services of Choithram Hospital and Research Centre (CHRC), Indore (a teaching hospital), were enrolled prospectively in the study during the period February 2017 to February 2018. The patients were further classified three risk groups according to serum hs-CRP levels. < 1 mg/L - low risk, 1-3 mg/L - average risk and >3 mg/L- high risk.

Results: In our study, majority of the patients were having serum hs-CRP level >3mg/l putting them in high risk category. Of 100 patients, 60 patients (60%) had serum hs-CRP level > 3mg/l, 33 patients (33%) were having serum hs-CRP level 1-3mg/l, while only 7 patients (7%) had serum hs-CRP level < 1.

The mean value of the serum hs-CRP levels in our study were 4.18±3.30 mg/L. In patients with unstable angina serum hs-CRP was 2.43±1.67 mg/l, with NSTEMI it was 3.70±2.09 mg/l and with STEMI it was highest 5.41±3.83 mg/l,

Conclusion: In our study we showed, the mean value of the serum hs-CRP levels in Indian subjects were 4.18±3.30 mg/L, which is higher to those reported in other ethnic groups.

1. Libby P. Current concepts of the pathogenesis of the acute coronary Circulation. 2001;104:365-72.
2. Third universal definition of myocardial infarction European Heart Journal (2012) 33, 2551–2567.
3. Zebrack JS, Muhlestein JB, Home BD, Anderson JL, Intermountain Heart Collaboration Study Group. C-reactive protein and angiographic coronary artery disease: independent and additive predictors of risk insubjects with angina. J Am Coll Cardiol 2002;39:632-637.
4. Erren M, Reinecke H, Junker R, Fobker M, Schulte H, Schurek JO, et al. Systemic inflammatory parameters in patients with atherosclerosis of the coronary and peripheral arteries. Arterioscler Thromb Vasc Biol 1999;19:2355-2363.
5. Taniguchi H, Momiyama Y, Ohmori R, Yonemura A,Yamashita T, Tamai S, et al. Association of plasma C-reactive protein levels with presence and extent of coronary stenosis in patients with stable coronary artery disease. Atherosclerosis 2005;178:173-177.
6. Chandalia M, Cabo-Chan AV Jr, Devaraj S, JialalI, Grundy SM, Abate N. Elevated plasma highsensitivity C-reactive protein concentrations in Asian Indians living in the United States. J Clin Endocrinol Metab 2003;88:3773-6.
7. Chambers JC, Eda S, Bassett P, Karim Y, Thompson SG, Gallimore JR, et al. C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in Indian Asians from the United Kingdom compared with European whites. Circulation 2001;104:145-50.
8. Dalan R, Jong M, Chan SP, Hawkins R, Choo R, Lim B, et al. High-sensitivity C-reactive protein concentrations among patients with and without diabetes in a multiethnic population of Singapore: CREDENCE Study. Diabetes Metab Syndr Obes 2010;3:187-95.
9. Indulekha K, Surendar J, Mohan V. High sensitivity C-reactive protein, tumor necrosis factor-?, interleukin-6, and vascular cell adhesion molecule-1 levels in Asian Indians with metabolic syndrome and insulin resistance (CURES-105). J Diabetes Sci Techno 2011;5:982-8.
10. Deepa R, Velmurugan K, Arvind K, Sivaram P, Sientay C, Uday S, et al. Serum levels of interleukin 6, C-reactive protein, vascular cell adhesion molecule 1, and monocyte chemotactic protein 1 in relation to insulin resistance and glucose intolerance--the Chennai Urban Rural Epidemiology Study (CURES). Metabolism2006;55:1232-8.
11. Espliguero RA, Avanzas P, Sales JC, Aldama G, Pizzi C,Kaski JC. reactive protein elevation and disease activity in patients with coronary artery disease. Eur Heart J 2004;24:401–8.
12. Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease:application to clinical and public health practice:a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107:499-511.
13. Espliguero RA, Avanzas P, Sales JC, Aldama G, Pizzi C,Kaski JC. reactive protein elevation and disease activity in patients with coronary artery disease. Eur Heart J 2004;24:401–8.
14. Moreira GC, Cipullo JP, Martin JF, Ciorlia LA, Godoy MR, Cesarino CB, et al. Evaluation of the awareness, control and cost-effectiveness of hypertension treatment in a Brazilian city:populational study. J Hypertens 2009;27:1900-1907
15. Frohlich, M, Sund, M, Lowel, H, Imhof, A, Hoffmeister, A, and Koenig, W. Independent association of various smoking characteristics with markers of systemic inflammation in men. Results from a representative sample of the general population (MONICA Augsburg Survey 1994/95). Eur Heart J. 2003;24:1365-1372.
16. Geffken, DF, Cushman, M, Burke, GL, Polak, JF, Sakkinen, PA, and Tracy, RP. Association between physical activity and markers of inflammation in a healthy elderly population. Am J Epidemiol. 2001;153:242-250.
17. Hutchinson, WL, Koenig, W, Frohlich, M, Sund, M, Lowe, GD, and Pepys, MB. Immunoradiometric assay of circulating C-reactive protein:age-related values in the adultgeneral population. Clin Chem. 2000;46:934-938.
18. Imhof, A, Woodward, M, Doering, A, Helbecque, N, Loewel, H, Amouyel, P, Lowe, GDO, and Koenig, W. Overall alcohol intake, beer, wine, and systemic markers of inflammation in western Europe: Results from three MONICA samples (Augsburg, Glasgow, Lille). European Heart Journal. 2004;25:2092-2100.

Dr Priyanka Kiyawat

Asst. Prof., Dept. of Pathology,

Sri Aurobindo Medical College and PG Institute, Indore (M.P.)