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LETTER TO THE EDITOR

Letter to the Editor: C-reactive protein and cardiovascular events in obstructive and nonobstructive coronary artery disease

Sookaromdee, Pathum1,∗; Wiwanitkit, Viroj2

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doi: 10.1097/CP9.0000000000000010
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Dear Editor,

We would like to share ideas on “The relationship between c-reactive protein and cardiovascular events in patients with obstructive and nonobstructive coronary artery disease[1].” Zhang et al. concluded that “Patients with NOCAD had worse outcomes and elevated hs-CRP levels were… risk in NOCAD patients[1].” We agree that CRP might be a useful biomarker. However, CRP is affected by many confounding factors. High background CRP is reported in an individual who is a silent carrier of hemoglobinopathy[2–3]. Also, a person with a nutritional problem, such as iron deficiency disorder, might have an abnormal background CRP level[4]. When assessing the risk, consideration of possible background confounding factors is needed.

Conflict of interest statement

The authors declare that they have no conflict of interest with regard to the content of this manuscript.

References

[1]. Zhang HW, Guo YL, Zhu CG, et al. The relationship between C-reactive protein and cardiovascular events in patients with obstructive and nonobstructive coronary artery disease. Cardiol Plus 2021; 6:166–173. doi: 10.4103/2470-7511.327240.
[2]. Kanavaki I, Makrythanasis P, Lazaropoulou C, et al. Adhesion molecules and high-sensitivity C-reactive protein levels in patients with sickle cell beta-thalassaemia. Eur J Clin Invest 2012; 42:27–33. doi:10.1111/j.1365-2362.2011.02551.x.
[3]. Makis AC, Hatzimichael EC, Stebbing J, et al. C-reactive protein and vascular cell adhesion molecule-1 as markers of severity in sickle cell disease. Arch Intern Med 2006; 166:366–368. doi:10.1001/archinte.166.3.366.
[4]. Ru Y, Pressman EK, Cooper EM, et al. Iron deficiency and anemia are prevalent in women with multiple gestations. Am J Clin Nutr 2016; 104:1052–1060. doi:10.3945/ajcn.115.126284.
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