title: High levels of C-reactive protein with low total cholesterol concentrations additively predict all-cause mortality in patients with coronary artery disease.
abstract: BACKGROUND
  This study aimed to investigate independent and additive predictive effects of raised C-reactive protein (CRP) levels and decreased total cholesterol levels on mortality in patients with chronic coronary artery disease (CAD). Low total cholesterol (TC) levels are associated with worsened survival in chronic and acute diseases. Elevated CRP level is an important predictor of vascular events and mortality in patients with CAD. Potential inhibition of immune activation by circulating lipoproteins could be a link between cholesterol and inflammatory markers.
  
  
  METHODS
  A group of 387 patients (median age 59 years) with CAD and with or without severe heart failure (HF) were followed for a median of 5.06 years. Serum total cholesterol and CRP concentrations were measured at enrollment.
  
  
  RESULTS
  The relationship between lipoproteins, CRP and survival was explored. High CRP concentrations were in significant association with severity of HF and predicted worsened survival in patients with CAD (hazard ratio 5.214, 95% CI 1.762-15.427). The association between CRP levels and mortality was independent of potential confounding factors such as age, body-mass index, severity of HF, smoking habits, hypertension and TC levels. The prediction of mortality by low TC levels was significant (hazard ratio 2.932, 95% CI 1.021-8.422). Furthermore, patients with increased CRP and decreased TC (additive predictive effect) phenotype had 11.714-times higher risk (95% CI 2.619-52.385) of being nonsurvivors than patients with low CRP/high TC.
  
  
  CONCLUSIONS
  High CRP levels and low TC concentrations are independent and additive predictors of mortality in patients with CAD. Our data indicate that joint analysis of circulating lipoproteins and inflammatory biomarkers may improve prediction of survival in patients with CAD.
authors.affiliation: IIIrd Department of Medicine, Semmelweis University, Kútvölgyi st. 4., H-1125 Budapest, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Jánoskuti
authors.forename: Z
authors.initials: Z
authors.lastname: Förhécz
authors.forename: N
authors.initials: N
authors.lastname: Hosszúfalusi
authors.forename: M
authors.initials: M
authors.lastname: Kleiber
authors.forename: S
authors.initials: S
authors.lastname: Walentin
authors.forename: O
authors.initials: O
authors.lastname: Bálint
authors.forename: J
authors.initials: J
authors.lastname: Duba
authors.forename: S
authors.initials: S
authors.lastname: Rugonfalvi-Kiss
authors.forename: L
authors.initials: L
authors.lastname: Romics
authors.forename: I
authors.initials: I
authors.lastname: Karádi
authors.forename: G
authors.initials: G
authors.lastname: Füst
authors.forename: Z
authors.initials: Z
authors.lastname: Prohászka
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D002784:Cholesterol / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D002097:C-Reactive Protein; D002784:Cholesterol