A population-based transesophageal echocardiographic study strongly suggests that an increase in C-reactive protein may mark atherosclerosis in the thoracic aorta long before a cardiovascular event occurs, according to an article in the September 13th issue of Archives of Internal Medicine.

The study of 386 residents of a single rural area used transesophageal echocardiography (TEE) to obtain high-quality images of the lining of the thoracic aorta. The images are clearer than traditional echocardiograms because imaging of the heart and major blood vessels is done without interference from the ribs and chest wall.

The researchers found atherosclerotic plaques in the aortas of 69 percent of the study subjects (median age, 66 years). The level of high-sensitivity C-reactive protein (hs-CRP), a marker for inflammation, was the single factor most closely associated with the presence of plaques and their severity.

“This study is important because for the first time it gives us data on cholesterol, hs-CRP and other risk factors from people randomly selected from the community, and lets us correlate those results with the presence or absence of plaques,” says Bijoy Khandheria, MD, a coauthor of the study. “We have known for some time that hs-CRP levels are elevated among patients with chest pain or other heart-related symptoms. This new study tells us high C-reactive protein is a sign that plaques likely are being formed in the arteries, even if the person feels healthy. Our findings provide a missing link between inflammatory markers in the bloodstream and the increased risk of a cardiovascular event such as a myocardial infarction.”

Khandheria said the findings should cause doctors to take a closer look at patients who have elevated hs-CRP readings and that doctors and patients should work together to reduce other risk factors. “Among our study volunteers with no heart disease symptoms who were found through transesophageal echocardiography to have aortic plaques, a doubling of the hs-CRP nearly doubled the chances that the plaque would be a thicker, more dangerous one. For people who have an elevated hs-CRP, we believe it’s just a matter of time before they have a plaque buildup unless they take action. They need to be treated aggressively with aspirin and a statin to reduce inflammation and lower their cholesterol, and work to bring their weight and blood pressure down to recommended levels.”