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Analysis and modelling of cholesterol and high-density lipoprotein cholesterol changes across the range of C-reactive protein levels in clinical practice as an aid to better understanding of inflammation–lipid interactions
  1. Hanna Johnsson1,
  2. Maurizio Panarelli1,
  3. Allan Cameron2,
  4. Naveed Sattar3
  1. 1Department of Biochemistry, Glasgow Royal Infirmary, Glasgow, UK
  2. 2Department of Acute Medicine, Glasgow Royal Infirmary, Glasgow, UK
  3. 3Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Hanna Johnsson, Department of Biochemistry, Glasgow Royal Infirmary, Glasgow, G4 0SF UK; h.johnsson{at}


Objectives Raised total cholesterol (TC) and reduced high-density lipoprotein (HDL) cholesterol levels are established cardiovascular disease (CVD) risk factors. However, in autoimmune conditions the lipid–CVD association appears paradoxical, with inflammation as a potential confounding factor. We therefore sought to model the relationship between systemic inflammatory illness and lipid levels using C-reactive protein (CRP) as the prototypical marker of inflammation. Our hypothesis was that there would be an inverse association between raised CRP levels and both TC and HDL-cholesterol levels.

Methods Results from samples analysed simultaneously for CRP and lipids in a 6-month period were collected retrospectively from a large city hospital laboratory database that collates results from both primary and secondary care. The relationships between CRP and lipids were determined using graphical techniques and empirical, non-parametric, best fit models.

Results A total of 11 437 blood samples was included. We identified a significant (p<0.001) biphasic relationship between TC and CRP: TC increased within the healthy CRP range of less than 5 mg/l, but decreased with CRP levels above 10 mg/l. The two effects approximately cancelled each other out in the intermediate CRP range of 5–10 mg/l. There was an inverse relationship between HDL-cholesterol and CRP.

Conclusions Lipid levels change significantly during inflammatory illness in a population with both acute and chronic conditions. These results provide a strong epidemiological basis for the better understanding of lipid changes in inflammatory conditions and with anti-inflammatory therapies.

  • Cardiovascular Disease
  • Inflammation
  • Lipids

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