Prognostic significance of the Centers for Disease Control/American Heart Association high-sensitivity C-reactive protein cut points for cardiovascular and other outcomes in patients with stable coronary artery disease.

Abstract

BACKGROUND:

Data supporting the prognostic significance of high-sensitivity C-reactive protein (hs-CRP) are derived largely from individuals with no overt coronary artery disease or from patients with acute coronary syndromes. In contrast, the ability of hs-CRP to predict outcomes in patients with stable coronary artery disease and the prognostic significance of the Centers for Disease Control/American Heart Association hs-CRP cut points in such a population remain relatively unexplored.

METHODS AND RESULTS:

We measured hs-CRP in 3771 patients with stable coronary artery disease from the Prevention of Events With Angiotensin-Converting Enzyme Inhibition (PEACE) trial, a randomized placebo-controlled trial of the angiotensin-converting enzyme inhibitor trandolapril. Patients were followed up for a median of 4.8 years for cardiovascular death, myocardial infarction, or stroke, as well as new heart failure and diabetes. After adjustment for baseline characteristics and treatments, higher hs-CRP levels, even >1 mg/L, were associated with a significantly greater risk of cardiovascular death, myocardial infarction, or stroke (hs-CRP 1 to 3 mg/L: adjusted hazard ratio, 1.39; 95% CI, 1.06 to 1.81; P=0.016; hs-CRP >3 mg/L: adjusted hazard ratio, 1.52; 95% CI, 1.15 to 2.02; P=0.003). Similarly, elevated hs-CRP levels were an independent predictor of new heart failure (adjusted P<0.001 for trend) and new diabetes (adjusted P<0.001 for trend). There were no significant interactions between hs-CRP levels and the effects of trandolapril on any of the above outcomes.

CONCLUSIONS:

In stable coronary artery disease, an elevated hs-CRP level, even >1 mg/L, is a significant predictor of adverse cardiovascular events independently of baseline characteristics and treatments. An elevated hs-CRP does not appear to identify patients with stable coronary artery disease and preserved ejection fraction who derive particular benefit from angiotensin-converting enzyme inhibition.

• Authors: Marc S Sabatine, David A Morrow, Kathleen A Jablonski, Madeline Murguia Rice, J Wayne Warnica, Michael J Domanski, Judith Hsia, Bernard J Gersh, Nader Rifai, Paul M Ridker, Marc A Pfeffer, Eugene Braunwald, PEACE Investigators
• Journal: Circulation (Circulation) Vol. 115 Issue 12 Pg. 1528-36 (Mar 27 2007) ISSN: 1524-4539 [Electronic] United States
• PMID: 17372173 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Indoles
• trandolapril
• C-Reactive Protein

Topics

• Aged
• Angioplasty, Balloon, Coronary
• Biomarkers
• C-Reactive Protein (analysis)
• Cardiovascular Diseases (mortality)
• Coronary Artery Bypass
• Coronary Disease (blood, complications, drug therapy, epidemiology)
• Diabetes Mellitus (epidemiology)
• Female
• Follow-Up Studies
• Humans
• Indoles (therapeutic use)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (epidemiology, surgery, therapy)
• Outcome Assessment, Health Care (standards)
• Predictive Value of Tests
• Prognosis
• Proportional Hazards Models
• Reference Standards
• Stroke (epidemiology)
• Survival Analysis