title: C-reactive protein and ischemia in users and nonusers of beta-blockers and statins: data from the Heart and Soul Study.
abstract: BACKGROUND
  Elevated levels of C-reactive protein (CRP) are associated with an increased risk of coronary events, but whether inflammation is associated with inducible ischemia in patients with stable coronary disease is unknown.
  
  
  RESULTS
  We recruited patients with known coronary disease from 2 VA Medical Centers and 1 University-based medical center for the Heart and Soul Study. We measured CRP levels in 118 participants who had exercise-induced ischemia and in 111 who did not have inducible ischemia, as determined by stress echocardiography. We used logistic regression to examine the risk of exercise-induced ischemia associated with elevated CRP. We found that 75% (39/52) of participants in the highest CRP category (>0.38 mg/dL) had inducible ischemia, compared with 45% (79/177) in the lower 4 categories combined (adjusted odds ratio 4.2; 95% confidence interval 1.6 to 11; P=0.004). However, this association differed in users and nonusers of beta-blockers and statins. Among 89 participants who did not use beta-blockers, 93% in the highest CRP category had exercise-induced ischemia, compared with 42% in the lower 4 categories (P=0.03). Among 67 participants who did not use statins, 94% in the highest CRP category had exercise-induced ischemia, compared with 44% in the lower 4 categories (P=0.009). We did not observe a significant association between CRP and ischemia among participants who were treated with either of these medications.
  
  
  CONCLUSIONS
  Elevated CRP levels are associated with inducible ischemia in patients with stable coronary disease, particularly among those not treated with beta-blockers or statins.
authors.affiliation: Department of Medicine, University of California, San Francisco, USA.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Beattie
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Haiying
authors.initials: H
authors.lastname: Liu
authors.forename: Warren S
authors.initials: WS
authors.lastname: Browner
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000367:Age Factors; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005080:Exercise Test; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein