Envenenamentos por serpentes do gênero Bothrops provocam reações sistêmicas e locais como coagulopatias, hemorragias, reação inflamatória, dor e mionecrose. Proteínas secretadas ricas em cisteínas (CRISPs) estão presentes nas peçonhas de serpentes e estão amplamente distribuídas entre mamíferos, répteis e anfíbios. Estão envolvidas em algumas reações biológicas, porém muitas funções ainda são desconhecidas. O presente trabalho objetivou o isolamento, a caracterização bioquímica/estrutural, enzimática e funcional, a avaliação do potencial inflamatório e avaliação da atividade sobre o sistema complemento de uma CRISP isolada da peçonha de Bothrops jararaca. A CRISP denominada BJ-CRP, foi isolada da peçonha de Bothrops jararaca através da combinação de três etapas cromatográficas: exclusão molecular em Sephacryl S-200, cromatografia de troca aniônica em coluna Source 15Q e cromatografia de fase reversa em coluna C18. O grau de homogeneidade foi determinado e confirmado por eletroforese SDS-PAGE, que mostrou uma banda única de 25,19 kDa, e por MALDI-TOF/TOF que apresentou a massa molecular de 24,6 kDa. A sequência N-terminal e a análise dos peptídeos trípticos por MALDI TOF/TOF demonstrou a presença de 100 resíduos de aminoácidos, os quais apresentaram até 96% de similaridade com sequências de outras CRISPs já descritas, porém de outros gêneros e espécies de serpentes, pois ainda não há CRISPs isoladas do gênero Bothrops. A BJ-CRP não possui atividade proteolítica sobre a azocaseína, o fibrinogênio e a fibrina. Também não apresentou atividade coagulante e hemorrágica, e não demonstrou atividade quando testada na concentração de 1?M em 13 diferentes canais para potássio dependentes de voltagem. Por outro lado, esta toxina foi capaz de induzir um processo inflamatório agudo (tempos de 1 e 4 horas), observado pelo recrutamento de neutrófilos e aumento da citocina pró-inflamatória IL-6 na cavidade peritoneal de camundongos. Ensaios realizados com a BJ-CRP e a peçonha de Bothrops jararaca mostraram modulação na atividade hemolítica promovida pela via clássica do sistema complemento. A BJ-CRP também promoveu ação direta sobre alguns componentes isolados do sistema complemento, como C3 e C4, conforme avaliado por SDS-PAGE e Western blot. O presente trabalho descreve a purificação da BJ-CRP, a primeira CRISP isolada da peçonha da serpente do gênero Bothrops. Os resultados obtidos são promissores e abrem perspectivas para o melhor entendimento desta classe de proteínas, e para a compreensão do mecanismo de ação desta classe de toxinas na resposta inflamatória induzida pelo envenenamento botrópico. / Envenomation by snakes from Bothrops genus is characterized by systemic and local effects such as coagulopathies, bleeding disorders, inflammation, pain and myonecrosis.The cysteine rich secretory proteins (CRISPs) are present in snake venoms and are widely distributed mammals, reptiles and amphibians. They are involved in certain biological activities, however many of their functions are still unknown. The aim of the present study was to isolate a CRISP from Bothrops jararaca and to biochemically/functionally characterize it by evaluating its involvement on inflammatory responses and on the complement system. The CRISP named BJ-CRP was isolated from Bothrops jararaca crude venom through the combination of three chromatographic steps: molecular exclusion on Sephacryl S-200 column, anion exchange chromatography on Source 15Q and reverse phase chromatography using C18 column. A high purity degree was obtained as confirmed by SDSPAGE, showing a single band of 25.19 kDa, and by MALDI-TOF/MS showing a molecular mass of 24.6 kDa. The N-terminal sequence and analysis of tryptic peptides by MALDI TOF/ MS resulted in the determination of 100 amino acid residues, which had up to 96% similarity to sequences from other snake venom CRISPs that were previously described, but from other genus and snake species. The BJ-CRP did not have proteolytic activity on azocasein, fibrinogen or fibrin. It did not show coagulant or hemorrhagic activity, and also did not show activity on 13 different voltage dependent potassium channels when tested at a concentration of 1?M. Moreover, this toxin was able to induce an acute inflammatory response (1 and 4 hours after injection), observed by the recruitment of neutrophils and increase of interleukin-6 into the peritoneal cavity of mice. BJ-CRP and B. jararaca crude venom were capable of modulating the hemolytic activity promoted by the classical pathway of the complement system, and BJ-CRP also showed direct action on some complement system components, such as C3 and C4 as evaluated by SDS-PAGE and Western blot. The present work describes the purification of BJ-CRP, the first CRISP isolated from a Bothrops snake venom. The results obtained showed to be promising and open up prospects in order to better understand the involvement of this class of toxins in the inflammatory response induced by Bothrops envenomation.

Les bactéries sont en permanence confrontées à des changements d'environnements. La régulation transcriptionnelle joue alors un rôle majeur dans l'adaptation des bactéries. En particulier, la bactérie phytopathogène D. dadantii s'est récemment adaptée à l'hôte végétal. Elle produit en particulier des pectate lyases (Pel) qui dégradent la pectine, ciment des parois végétales, et jouent un rôle majeur dans le développement de la maladie. Les gènes pelD et pelE, malgré la forte divergence dans leur expression, sont issus d'un transfert horizontal suivi d'une duplication récente. La question de l'intégration de ces gènes avec les régulations préexistantes s'est alors posée.Dans un premier temps, les mécanismes moléculaires détaillés de la régulation de pelD ont été étudiés. Il a été montré que cette régulation s'appuie sur un promoteur divergent de forte affinité pour l'ARN polymérase mais de faible efficacité pour la transcription et sur un arrangement stratégique de quatre sites de fixation de répresseur FIS et deux sites de l'activateur CRP. Tous ces éléments interagissent entre eux pour produire une régulation fine de l'expression de pelD. L'origine de la divergence régulatrice entre les paralogues pelD et pelE a par la suite été explorée. De manière surprenante, la divergence entre ces deux gènes et leur sélection s'appuie presque exclusivement sur un décalage de la position du promoteur de pelE (« TSS turnover ») qui l'a transformé en initiateur de la dégradation de la pectine. Ce mécanisme très fréquent chez les eucaryotes pluricellulaires (homme, drosophile, souris…) n'avait jamais encore été décrit chez les bactéries.A travers l'étude des promoteurs pelD et pelE de D. dadantii, de nouveaux mécanismes renforçant l'importance de la régulation transcriptionnelle dans les processus adaptatifs ont ainsi été découverts / Bacteria face frequent environmental changes. Transcriptional regulation plays a major role in the adaptation to these changes. In particular, the phytopathogen bacteria Dickeya have recently adapted to vegetal hosts. They produce Pecate lyases (Pel), among others, to degrade pectin in plant cell walls, which is necessary for disease development. The pelD and pelE genes, despite the strong divergence in their expression, originate from a horizontal gene transfer followed by a recent duplication. This raises the question of their integration into the preexisting regulatory networks.Detailed molecular mechanisms of the transcriptional regulation of pelD were studied first. It was shown that this regulation relies on a high-affinity but low transcription efficiency divergent promoter and a strategic arrangement of four FIS repressor binding sites and two CRP activator binding sites. These elements interact together to fine-tune the expression of pelD. Next, the origin of the regulatory divergence between the paralogous genes pelD and pelE was explored. Surprisingly, their divergence and selection relies mostly on a TSS turnover which happened on the pelE regulatory region and transformed pelE into an initiator of pectin degradation. This widespread phenomenon in multicellular eukaryotes (human, fly, mouse…) had not yet been seen in bacteria. To conclude, through the study of D. dadantii pelD and pelE promoters, new mechanisms highlighting the relevance of transcriptional regulation in adaptation were discovered in this work

L’étude des marqueurs biologiques dans la broncho-pneumopathie chronique obstructive (BPCO) et l'asthme, deux maladies respiratoires chroniques affectant des millions de personnes dans le monde, pourrait améliorer leur diagnostic, leur traitement et leur prévention.Cette thèse comprend deux parties. La première visait à évaluer l'association entre un marqueur spécifique des poumons, la protéine surfactant D (SP-D) sérique, et la BPCO, et à trouver un seuil de SP-D capable de discriminer les patients BPCO des témoins. Elle a été réalisée dans le cadre d’une étude cas-témoin au Liban incluant des patients BPCO (n=90), des asthmatiques (n=124) et des témoins (n=180). La deuxième partie visait à évaluer les associations chez les adultes des marqueurs de l’inflammation systémique (protéine C-réactive ultra-sensible, hs-CRP (n=252), et des cytokines (n=283)) et des marqueurs de dommages dus au stress oxydant (8-isoprostanes 8-IsoPs (n=258) du condensat de l’air exhalé) avec les phénotypes de l’asthme.Elle a été réalisée dans le cadre de l'étude épidémiologique longitudinale Française des facteurs génétiques et environnementaux de l'asthme (EGEA).Les résultats ont montré que les niveaux de SP-D sériques étaient associés positivement avec la BPCO et des seuils des niveaux de SP-D chez ces patients ont été identifiés avec d'excellentes valeurs discriminantes. Dans EGEA, aucune association n'a été trouvée entre les niveaux de hs-CRP sériques et le contrôle de l’asthme. Des profils de cytokines sériques (identifiés par analyse en composante principale) avec des niveaux élevés d’interleukine(IL)-1Ra et d’IL-10 ont été associés avec moins de crises d'asthme et un risque plus faible d'un mauvais contrôle de l'asthme sept ans plus tard. Les résultats des analyses préliminaires sur les associations entre les niveaux de 8-IsoPs et les phénotypes de l'asthme sont également présentés.Globalement, ces résultats ont montré l'utilité d'étudier les marqueurs biologiques en lien avec la BPCO et l'asthme. / Studying the biological markers in chronic obstructive pulmonary disease (COPD) and asthma, two chronic respiratory diseases affecting millions of individuals around the world, could improve their diagnosis, their treatment and their prevention.This thesis includes two parts. The first aimed to assess the association between a lung-specific biomarker, serum Surfactant Protein D (SP-D), and COPD, and to find cut-off points able to discriminate COPD patients from controls using SP-D levels. It was performed in a case-control study in Lebanon including COPD (n=90) and asthma patients (n=124) and controls (n=180). The second part aimed to assess the cross-sectional and longitudinal associations in adults for systemic inflammatory biomarkers (high sensitivity C reactive protein hs-CRP (n=252) and cytokines (n=283) as well as biomarkers of damage due to oxidative stress (8-Isoprostanes 8-IsoPs (n=258) from the exhaled breath condensate) and asthma outcomes.It was performed in the French longitudinal epidemiological study on the genetics and environmental factors of asthma (EGEA).Results showed that serum SP-D levels were positively associated with COPD and thresholds for SP-D levels in these patients were identified with excellent discriminant values. In EGEA, no association was found between serum hs-CRP levels and asthma control. Serum cytokine profiles (identified by principal component analysis) with high levels of interleukin (IL)-1Ra and IL-10 were associated with less asthma attacks and lower risk of poor asthma control in adults seven years later. The results of the preliminary analyses on the associations between the levels of 8-IsoPs and asthma outcomes are also presented.Overall, these results have shown the usefulness of studying the biological markers related to COPD and asthma.

Maîtriser la biocontamination surfacique et les risques susceptibles d’y être associés demeure un challenge majeur. Cette maîtrise passe par la préparation de nouveaux matériaux polymères possédant des propriétés de surface adaptées. Dans cette optique le LCOM développe depuis quelques années une thématique consistant à mettre au point des méthodes de modifications de surfaces de matériaux polymères par greffage de biomolecules. [ ] [ ] [ ] Dans ce contexte, l’objectif de cette étude est de fonctionnaliser des films polymères de type poly (téréphtalate d’éthylène) (PET) avec des dérivés sucrés et/ou polysaccharides dans le but d’étudier le caractère bactériostatique, biocide et pro ou anti-adhésion. [ ] La préparation des matériaux se fait en plusieurs étapes :Etape 1 : Fonctionnalisation de surfaces polymères (films) par traitement plasma N2/H2 et NH3 pour introduire à la surface des fonctions amines. Cette technique modifie la surface sans changer les propriétés intrinsèques des matériaux.Etape 2 : Greffage d’un amorceur de polymérisation radicalaire par transfert d’atome (ATRP)Etape 3 : Polymérisation en surface d’un monomère sucré par ATRP (contrôle de la longueur des chaînes greffées). La mise au point des paramètres de polymérisation ATRP de ces monomères est d’abord menée en solution avant d’étudier la polymérisation en surface.Etape 4 : Etudes microbiologiques des surfaces modifiées.Après chaque étape de modification de surface, les matériaux sont caractérisés par différentes méthodes d’analyses telles que : la spectroscopie de photoélectrons X (XPS), la microscopie à force atomique, la chromatographie d’exclusion stérique. Des glycopolymères protégés et déprotégés issus du galactose et de la glucosamine ont été synthétisés. Ceux issus de la glucosamine ont été synthétisés afin de mimer les propriétés antibactériennes du chitosane. Le glycomonomère issu du galactose est polymérisé par ATRP par voie « grafting from » sur des surfaces de PET. Ces surfaces modifiées présentent des propriétés anti-adhésives intéressantes contre les bactéries du type Bacillus subtilis. En effet, après greffage du glycomonomère déprotégé, il n’ ya plus d’adhésion de bactéries. Des polymères contenant des fonctions ammonium quaternaire et fluor ont aussi été greffés avec succès sur les films de PET par la même méthode. / Control surface contamination by microorganism is of great concern in a variety of areas such as food packaging, medical devices, hospitals and so on. To reduce or prevent microbial adhesion, new polymer surfaces must be developed. In this context, we investigate a new theme which deals with the modification of polymer materials containing carbohydrate molecules. , , The aim of the study is to attach covalently glycopolymers or potential antimicrobial polymers on films of polyethylene terephthalate (PET) in order to study the biocidal or anti-fooling properties. Indeed, grafting glycopolymers on PP fibers have brought anti-fooling properties. The surfaces are prepared in several steps:Step 1: Incorporation of primary amino groups by N2/H2 or NH3 plasma treatment. The pretreatment by plasma exhibits many benefits for the surface modification, which enables to introduce functional groups at the surface without any modification of the chemical and mechanical properties of the material during the process.Step 2: Insertion of Atom Transfer Radical Polymerization (ATRP) initiatorStep 3: Grafting from surface polymerization method of a monomer in order to control the molecular weight distribution on the surfaces. ATRP parameters of glycomonomers are studied in solution before carrying polymerization on surfaces.Step 4: Microbial adhesion tests of modified surfaces with Bacillus Subtilis and Lactoccocus Lactis as bacterial strains. Several analytical techniques such as X-ray photoelectron spectroscopy (XPS), Atomic Force Microscopy, size exclusion chromatography of polymers obtained in solution have been used to characterize the modified surfaces. The first step was to optimize plasma parameters in order to have a high density of primary amino group on the surfaces. Then several monomers have been studied especially glycomonomers from galactose and glucosamine to mimic antimicrobial properties of chitosan. Protected and deprotected glycopolymers from galactose polymerized on PET surfaces exhibit anti-fooling properties toward Bacillus Subtilis. Polymers containing quaternary ammonium salt or fluor have also been successfully polymerized by a grafting from method on PET films.

Introduction: In Africa, it is estimated that cardiovascular disease (CVD) will affect approximately 1.3 million people per annum over the following 20 years. C-reactive protein (CRP) is a predictor of CVD risk and certain CRP gene polymorphisms can result in altered CRP concentrations. The distribution of CRP gene polymorphisms is ethnic-specific and extrapolating information from other populations to the black South African population, reported to harbour considerable genetic variation, should be avoided. This highlights the fact that genetic research among black South Africans is necessary. Objectives: The main aim of this dissertation was to determine the association between various polymorphisms (reported and novel [single nucleotide polymorphisms (SNPs)] within the CRP gene with CRP concentrations [measured as high sensitivity (hs)-CRP concentrations] in a black South African population undergoing an epidemiological transition. Interactions between specific CRP polymorphisms and certain environmental factors on hs-CRP concentrations were also investigated. Methods: This cross-sectional study (n=1,588) was nested within the Prospective Urban and Rural Epidemiological (PURE) study. Genotyping was performed using Illumina VeraCode technology on the BeadXpress® platform. Hs-CRP concentrations were measured by the use of a sequential multiple analyser computer (SMAC) through a particle-enhanced immunoturbidometric assay. Results: All the SNPs adhered to the assumptions of Hardy-Weinberg equilibrium, although the distribution of several SNPs differed from that reported in other population groups. Three SNPs (rs3093058, rs3093062 and rs3093068) were associated with a significant (p ≤ 0.05) increase in CRP concentrations. Five SNPs (rs1205, rs1341665, rs2794520, rs7553007 and rs2027471) were associated with a significant (p ≤ 0.05) decrease in CRP concentrations. This difference in effect was most probably due to changes in gene function brought about by the localisation of these SNPs in the CRP gene. Men and urban individuals were more likely to present with significant associations between the SNPs investigated and CRP concentrations. The difference in the prevalence of the alleles associated with higher CRP concentrations in this population compared to non-African populations could possibly explain the increased CRP concentrations that are observed in the black South African population. Gene-gender (rs1205, rs1341665 and rs2027474) as well as gene-environmental (rs3093068) interactions were also observed. Conclusions: CRP concentrations are in themselves a complex trait and there are many factors at play that influence their expression. Numerous factors (both genetic and environmental) are involved and no single factor acting alone is likely to have enough of an influence to be used as a clinical diagnostic test of CRP concentrations. These results provide valuable information on the regulation of CRP in a black South African population as well as contribute to the literature of CRP on a global level. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Introduction: In Africa, it is estimated that cardiovascular disease (CVD) will affect approximately 1.3 million people per annum over the following 20 years. C-reactive protein (CRP) is a predictor of CVD risk and certain CRP gene polymorphisms can result in altered CRP concentrations. The distribution of CRP gene polymorphisms is ethnic-specific and extrapolating information from other populations to the black South African population, reported to harbour considerable genetic variation, should be avoided. This highlights the fact that genetic research among black South Africans is necessary. Objectives: The main aim of this dissertation was to determine the association between various polymorphisms (reported and novel [single nucleotide polymorphisms (SNPs)] within the CRP gene with CRP concentrations [measured as high sensitivity (hs)-CRP concentrations] in a black South African population undergoing an epidemiological transition. Interactions between specific CRP polymorphisms and certain environmental factors on hs-CRP concentrations were also investigated. Methods: This cross-sectional study (n=1,588) was nested within the Prospective Urban and Rural Epidemiological (PURE) study. Genotyping was performed using Illumina VeraCode technology on the BeadXpress® platform. Hs-CRP concentrations were measured by the use of a sequential multiple analyser computer (SMAC) through a particle-enhanced immunoturbidometric assay. Results: All the SNPs adhered to the assumptions of Hardy-Weinberg equilibrium, although the distribution of several SNPs differed from that reported in other population groups. Three SNPs (rs3093058, rs3093062 and rs3093068) were associated with a significant (p ≤ 0.05) increase in CRP concentrations. Five SNPs (rs1205, rs1341665, rs2794520, rs7553007 and rs2027471) were associated with a significant (p ≤ 0.05) decrease in CRP concentrations. This difference in effect was most probably due to changes in gene function brought about by the localisation of these SNPs in the CRP gene. Men and urban individuals were more likely to present with significant associations between the SNPs investigated and CRP concentrations. The difference in the prevalence of the alleles associated with higher CRP concentrations in this population compared to non-African populations could possibly explain the increased CRP concentrations that are observed in the black South African population. Gene-gender (rs1205, rs1341665 and rs2027474) as well as gene-environmental (rs3093068) interactions were also observed. Conclusions: CRP concentrations are in themselves a complex trait and there are many factors at play that influence their expression. Numerous factors (both genetic and environmental) are involved and no single factor acting alone is likely to have enough of an influence to be used as a clinical diagnostic test of CRP concentrations. These results provide valuable information on the regulation of CRP in a black South African population as well as contribute to the literature of CRP on a global level. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

This study was designed to test the hypothesis that 60 days continuous head down bed rest (HDBR), an Earth-based analogue of the effects of space flight, would elevate factors that increase vasoconstriction and would increase markers of vascular inflammation. The study incorporated countermeasures consisting of treadmill running within lower-body negative pressure and resistive "flywheel" exercise (exercise countermeasure, EX) or an increased protein intake of 0. 6 g/kg body weight/day (dietary countermeasures, DIET) to determine whether these interventions might prevent the vasoconstrictor and inflammatory responses when compared to a control (CON) group. Markers of vascular health measured in the study include the vasoactive molecules angiotensin II (Ang II), endothelin-1 (ET-1), and nitric oxide metabolites (NO_met); and markers of inflammation including C-reactive protein (CRP), and the adhesion molecules E-selectin (E-sel), intracellular adhesion molecule-1 (ICAM), and vascular cell adhesion molecule-1 (VCAM). Twenty four women were housed at the MEDES clinic in Toulouse, France, as part of a large international study (Women International Space Simulation for Exploration, WISE) in which various experimental protocols and countermeasures were integrated into a single experimental design completed during two campaigns. Each 100 day campaign included 20 days of pre-testing (pre-HDBR), 60 days of bed rest (HDBR), and 20 days of post-testing (post-HDBR). The experimental countermeasures were applied only during the 60-day HDBR period. Following 60 days of HDBR, many changes occurred in the concentrations of the measured molecules. Specifically, the concentration of Ang II significantly increased in the CON and DIET groups (52. 9%, p = 0. 014; and 124. 4%, p <0. 0001 respectively), but not in the EX group. Also, NO_met decreased in all groups, with reductions in the EX and DIET groups (p = 0. 013, and p = 0. 056 respectively). Markers used to assess vascular inflammation increased following the HDBR. The increase in CRP in the CON and DIET groups and the decrease in the EX group from pre- to post-HDBR were not significant; however, the directional changes resulted in an interaction between group and HDBR (p = 0. 052). The adhesion molecule E-sel was significantly increased in the DIET group (p = 0. 003), and VCAM was significantly increased in the CON group (p = 0. 016) with a smaller increase in the DIET group (p = 0. 08). No changes in adhesion molecules were observed in the EX group. This study demonstrated that 60 days of HDBR by young, healthy, women caused changes in several different molecules that are beginning to emerge as risk factors for the development of cardiovascular diseases. Further, it was observed that regular, vigorous exercise during HDBR prevented these changes. These results suggest that future studies of this kind should directly monitor the effects of simulated space flight on vascular health in men and women to obtain a greater understanding of the adaptations that might occur during long term space exploration missions. HDBR can be considered an extreme model of physical inactivity and could be used to provide insight into mechanisms of disease processes associated with the sedentary lifestyle that is prevalent in Western society.

The patient population consisted of a maximum of 18,570 subjects who completed the NHANES III questionnaire and examination from 1988 - 1994. The physical examination included such things as body mass index and serum samples, social and medical history. The periodontal examination recorded probing depth, attachment loss and gingival bleeding. Serum samples were analyzed for CRP levels, cholesterol levels etc. Demographic, cardiovascular and oral health variables were compared in subjects with a history of heart attack. Result showed that history of heart attack is associated with increased odds ratio for elevated CRP, diabetes, hypertension, cholesterol, male gender, non-white race and smoking. Of the periodontal indicators of disease, only gingival bleeding had an increased odds ratio for association with heart attack history. The unadjusted odds ratio was 1.25 with 95% CI[0.84-1.87]. The adjusted odds ratio increase to 1.93 with 95% CI [1.02-3.71]. These findings are consistent with previous research indicating that elevated CRP is associated with increased risk of heart attack. The interesting finding of this study is that only gingival bleeding, not probing depth or attachment loss, had an increased odds ratio for an associated with self-reported history of heart attack.

Background: C-reactive protein (CRP) has been associated with increased risk of coronary heart disease (CHD) and stroke, but much of the research had focused on middle-aged populations with, limited prospective, population-based, longitudinal data. In this study, we examined data from an elderly population and described the distribution of CRP concentrations and the prevalence of elevated CRP levels (>3 mg/l), examined the association between CRP levels and incidence of CHD or ischemic stroke, and assessed the potential interaction of CRP with sex or race on the incidence of CHD or ischemic stroke.Methods: Baseline CRP levels were measured in a cohort of 57 13 participants 265 years of age from the Cardiovascular Health Study (CHS) using a high-sensitivity assay. The cohort included 3859 (68%) subjects free of cardiovascular disease and 1104 (19%) with existing CVD. Data were collected from 1989-1990 or 1992- 1993 to June 30, 1997. SAS 9.10 software was used for analyses and statistical tests included t test, ANOVA, χ2 Kaplan-Meier method, Log-rank test, and Cox proportional hazards regression. Results: CRP distribution was highly skewed toward higher values, thus necessitating the use of the median and log transformation of the mean. For all participants, the median of CRP concentrations was 1.92 mg/l; the geometric mean was1.97 mg/l. Thirty percent of participants had CRP values >3 mg/l. Among subjects with prevalent CHD and those free of CHD at baseline the median CRP levels were 2.32 mg/l and 1.75 mg/l, respectively. The prevalence of elevated CRP levels was 36% in participants with baseline CHD and 26% in those free of CHD; it was higher in women than in men (32% vs. 27%, respectively), in blacks than in whites (42% vs. 28%, respectively), in subjects taking versus not taking cardiovascular medicines (35% vs. 22%, respectively). The mean CRP were similar among participants with and without initial statin uses (P = 0.3 155). For CHD participants, 37% of statin users and 36% of nonusers had elevated CRP levels. During 8 years of follow-up, 270 incident CHD events and 245 incident ischemic strokes occurred. Incidence rate of CHD and ischemic stroke was 10.7 and 9.7 per 1000 person-years, respectively. The relative risk (RR) of CHD and ischemic stroke for CRP >3 mg/l compared with P for sex-CRP interaction, 0.7638; P for race-CRP interaction, 0.4428). Similarly, no effect modification was observed by sex and race in the association of CRP with ischemic stroke (P for sex-CRP interaction, 0.1721 ; P for race-CRP interaction, 0.5486). Conclusions: CRP levels were higher among prevalent CHD subjects than among those without CHD. Women, blacks, and CV drug users had elevated CRP levels. Elevated CRP was associated with increased 8-year risk of CHD and ischemic stroke. Neither sex nor race modified the association between CRP and CHD or ischemic stroke. Future studies will be needed to explore new CRP thresholds for the elderly, and to examine if reduction of CRP levels using pharmacological agents reduces the risk of CHD or stroke.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.