Document Type : Original Article(s)


1 Assistant Professor, Atherosclerosis Research Center AND Department of Cardiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Assistant Professor, Echocardiography Fellowship, Atherosclerosis Research Center AND Department of Cardiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

3 Cardiologist, Atherosclerosis Research Center AND Department of Cardiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

4 Clinical Research Development Unit, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz AND Department of Toxicology, Shahreza Branch, Islamic Azad University, Shahreza, Iran


BACKGROUND: High-sensitivity C-reactive protein (hs-CRP) inflammatory biomarker is one of the best informative markers of prognosis of coronary artery disease (CAD) that has been studied. Some studies have found that hs-CRP has a direct correlation with CAD. The aim of this study was to determine the relationship between serum levels of hs-CRP and the severity of coronary artery stenosis in patients with stable and unstable angina. METHODS: In a cross-sectional study, 150 patients undergoing coronary angiography in Golestan Hospital Ahvaz, Iran in 2012, were studied in three groups of stable angina (n = 50), unstable angina (n = 50), and normal coronary angiography (n = 50). Hs-CRP levels were measured in patients before angiography by enzyme-linked immunosorbent assay method, were compared between the three groups and its correlation with the degree of stenosis was evaluated. RESULTS: The mean levels of hs-CRP in the stable angina group, unstable angina group and the group with normal coronary angiography were 2.46 ± 1.79, 4.84 ± 3.38, and 2.95 ± 2.57 mg/L, respectively. The results show that the mean levels of hs-CRP in patients with unstable angina was significantly higher compared to patients with stable angina (P < 0.050) and patients with normal coronary angiography (P < 0.001). However, a statistical difference between the mean CRP levels in patients with stable angina and patients with normal angiography results was not seen (P > 0.050). A significant relationship between arterial stenosis points and hs-CRP levels in patients with stable angina was not seen (P = 0.985). CONCLUSION: The findings suggest that it seems hs-CRP level in patients with unstable angina were significantly higher than those in patients with stable angina and patients with normal coronary angiography. It also appears that the level of hs-CRP in patients with unstable angina is associated with the severity of coronary stenosis. Given the finding of consistent results, the use of hs-CRP as a prognostic factor in these patients may be useful.  


  1. Gupta S, Saxena SK, Lalchandani A, Chandra R, Gupta AC, Mishra MP. Significance of platelet volume indices in patients of coronary artery diseases (CAD) and acute myocardial infarction (mi): a new predictor for Ihd. Indian J Cardiolo 2012; 15(22-25).
  2. Zheng L, Luo G, Zhang J, Mu Q, Shi Y, Berggren-Soderlund M, et al. Decreased activities of apolipoprotein m promoter are associated with the susceptibility to coronary artery diseases. Int J Med Sci 2014; 11(4): 365-72.
  3. Vahedian Azimi A, Alhani F, Ahmadi F, Kazemnejad A. Effect of family-oriented empowerment model on the life style of myocardial infarction patients. Iran J Crit Care Nurs 2010; 2(4): 127-32.
  4. Shibata R, Ouchi N, Kikuchi R, Takahashi R, Takeshita K, Kataoka Y, et al. Circulating omentin is associated with coronary artery disease in men. Atherosclerosis 2011; 219(2): 811-4.
  5. Nesar Hosseini V, Taghipour M, Sharifian R, Hamta A, Feyzi S. Prevalence of coronary artery diseases risk factors in Sari-Iran (2005-10). J Gorgan Uni Med Sci 2013; 15(4): 96-100.
  6. Carlsson AC, Wandell PE, Gigante B, Leander K, Hellenius ML, de Faire U. Seven modifiable lifestyle factors predict reduced risk for ischemic cardiovascular disease and all-cause mortality regardless of body mass index: a cohort study. Int J Cardiol 2013; 168(2): 946-52.
  7. Wilson PW, D'Agostino R Sr, Bhatt DL, Eagle K, Pencina MJ, Smith SC, et al. An international model to predict recurrent cardiovascular disease. Am J Med 2012; 125(7): 695-703.
  8. Keramati MR, Nezafati MH. Multivariate predictors of blood transfusion in patients undergoing coronary artery bypass graft in Mashhad, Iran. Iran Red Crescent Med J 2008; 10(2): 79-83.
  9. Shemirani H, Separham KH. The relative impact of smoking or Hypertension on severity of premature coronary artery disease. Iran Red Crescent Med J 2007; 9(4): 177-81.
  10. Sharoni E, Kogan A, Medalion B, Stamler A, Snir E, Porat E. Is gender an independent risk factor for coronary bypass grafting? Thorac Cardiovasc Surg 2009; 57(4): 204-8.
  11. Trubnikova OA, Tarasova IV, Artamonova AI, Syrova ID, Barbarash OL. Age as a risk factor for cognitive impairments in patients undergoing coronary bypass. Neurosci Behav Physiol 2013; 43(1): 89-92.
  12. Hansson GK, Hermansson A. The immune system in atherosclerosis. Nat Immunol 2011; 12(3): 204-12.
  13. Libby P, Okamoto Y, Rocha VZ, Folco E. Inflammation in atherosclerosis: transition from theory to practice. Circ J 2010; 74(2): 213-20.
  14. Cimmino G, Ragni M, Cirillo P, Petrillo G, Loffredo F, Chiariello M, et al. C-reactive protein induces expression of matrix metalloproteinase-9: a possible link between inflammation and plaque rupture. Int J Cardiol 2013; 168(2): 981-6.
  15. Kals J, Kampus P, Kals M, Pulges A, Teesalu R, Zilmer K, et al. Inflammation and oxidative stress are associated differently with endothelial function and arterial stiffness in healthy subjects and in patients with atherosclerosis. Scand J Clin Lab Invest 2008; 68(7): 594-601.
  16. Ghodke SS, Padalkar RK, Bhagat SS, Ghone RA, Patil SM. hs- CRP: A "golden marker" of inflammation and coronary artery disease. Int J Health Sci Res 2012; 2(6): 42-6.
  17. Deshmukh A, Deshmukh A, G, Garg PK. Study of coronary artery disease risk factors and value of CRP in coronary risk determination in semi urban population of western U.P. India. Indian J Public Health Res Deve 2011; 2(1): 1-3.
  18. Wilson AM, Ryan MC, Boyle AJ. The novel role of C-reactive protein in cardiovascular disease: risk marker or pathogen. Int J Cardiol 2006; 106(3): 291-7.
  19. Biasucci LM, Koenig W, Mair J, Mueller C, Plebani M, Lindahl B, et al. How to use C-reactive protein in acute coronary care you have access. Eur Heart J 2013.
  20. Zakynthinos E, Pappa N. Inflammatory biomarkers in coronary artery disease. J Cardiol 2009; 53(3): 317-33.
  21. de Torres JP, Pinto-Plata V, Casanova C, Mullerova H, Cordoba-Lanus E, Muros de Fuentes M, et al. C-reactive protein levels and survival in patients with moderate to very severe COPD. Chest 2008; 133(6): 1336-43.
  22. Rao AD, Milbrandt EB. To JUPITER and beyond: statins, inflammation, and primary prevention. Crit Care 2010; 14(3): 310.
  23. Tiongco RH, Te CG, Punzalan FE, Gonda VM. High sensitivity CRP and short-term cardiovascular risk among patients with acute myocardial infarction: A two-center study. Acta Med Philipp 2012; 46(3): 64-8.
  24. Choi JH, Cho DK, Song YB, Hahn JY, Choi S, Gwon HC, et al. Preoperative NT-proBNP and CRP predict perioperative major cardiovascular events in non-cardiac surgery. Heart 2010; 96(1): 56-62.
  25. Salminen M, Kuoppamaki M, Vahlberg T, Raiha I, Irjala K, Kivela SL. Does high sensitive CRP improve cardiovascular risk prediction in metabolic syndrome among the aged? Scand Cardiovasc J 2013; 47(4): 210-6.
  26. Kablak-Ziembicka A, Przewlocki T, Sokolowski A, Tracz W, Podolec P. Carotid intima-media thickness, hs-CRP and TNF-alpha are independently associated with cardiovascular event risk in patients with atherosclerotic occlusive disease. Atherosclerosis 2011; 214(1): 185-90.
  27. Kojouri J, Karimi A, Pourafshar N, Vosoughi AR. Association between serum levels of hs-crp and ldl-c with degree of coronary artery stenosis in patients with stable angina pectoris. Iran Red Crescent Med J 2010; 12(4): 396-405.
  28. Nyandak T, Gogna A, Bansal S, Deb M. High sensitive c-reactive protein (hs-CRP) and its correlation with angiographic severity of coronary artery disease (CAD). J Indian Acad Clin Med 2007; 8(3): 217-21.
  29. Avanzas P, Arroyo-Espliguero R, Cosin-Sales J, Quiles J, Zouridakis E, Kaski JC. Multiple complex stenoses, high neutrophil count and C-reactive protein levels in patients with chronic stable angina. Atherosclerosis 2004; 175(1): 151-7.
  30. Rensburg MA, Matsha T, Hoffmann M, Hassan MS, Erasmus RT. Distribution and association of hs-CRP with cardiovascular risk variables of metabolic syndrome in adolescent learners. Afr J Lab Med 2012; 1(1): 6.
  31. Poon PY, Szeto CC, Kwan BC, Chow KM, Li PK. Relationship between CRP polymorphism and cardiovascular events in Chinese peritoneal dialysis patients. Clin J Am Soc Nephrol 2012; 7(2): 304-9.
  32. May EB, Scirica B, Bonaca M, Murphy S, Braunwald E, Morrow D. Prognostic value of high-sensitivity CRP for cardiovascular outcomes in Tra 2°p-timi 50. J Am Coll Cardiol 2013; 61(Suppl): 1162-6.
  33. Hamirani YS, Pandey S, Rivera JJ, Ndumele C, Budoff MJ, Blumenthal RS, et al. Markers of inflammation and coronary artery calcification: a systematic review. Atherosclerosis 2008; 201(1): 1-7.
  34. Khera A, de Lemos JA, Peshock RM, Lo HS, Stanek HG, Murphy SA, et al. Relationship between C-reactive protein and subclinical atherosclerosis: the Dallas Heart Study. Circulation 2006; 113(1): 38-43.
  35. Kazemi-Bajestani SM, Ghayour-Mobarhan M, Ebrahimi M, Moohebati M, Esmaeili HA, Ferns GA. C-reactive protein associated with coronary artery disease in Iranian patients with angiographically defined coronary artery disease. Clin Lab 2007; 53(1-2): 49-56.
  36. Masood A, Jafar SS, Akram Z. Serum high sensitivity C-reactive protein levels and the severity of coronary atherosclerosis assessed by angiographic gensini score. J Pak Med Assoc 2011; 61(4): 325-7.
  37. Assadpour Piranfa M, Beyranvand M R,
  38. Fartookzadeh S, Valaei N. Relation between hs-CRP level and severity of coronary artery stenosis. Pajouhesh Dar Pezeshki 2012; 36(3): 139-42. [In Persian].
  39. Luo JG. Relationship between serum IL-8 hsCRP, TNF-alpha and coronary lesions in CHD patients. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi 2010; 26(8): 789-91.
  40. Woloshin S, Schwartz LM. Distribution of C-reactive protein values in the United States. N Engl J Med 2005; 352(15): 1611-3.