C-reactive protein and angiographic characteristics of stable and unstable coronary artery disease: data from the prospective PREVEND cohort.
OBJECTIVE
High sensitive-C-reactive protein (hs-CRP) is associated with coronary risk, which may be explained by an association with (unstable) coronary artery disease (CAD). Until now, histopathological and angiographic studies have failed to consistently demonstrate a strong relationship. However, most of these studies were limited by a cross-sectional design. Our aim was to prospectively evaluate the association between hs-CRP and plaque instability. Therefore, firstly, we investigated the relation between hs-CRP measured long before coronary angiography (CAG) and angiographic characteristics of stable and unstable CAD. In addition, we investigated the association with coronary events during follow up in the total PREVEND population.


RESULTS
Of the population based Prevention of Renal and Vascular Endstage Disease (PREVEND) study, 8139 subjects without previous documented CAD were followed for the incidence of CAG and coronary events from 1997 to 2003. For the qualitative angiographic analysis, 216 CAGs were available. Mean time to CAG was 37+/-19 months. The 864 coronary vessels were graded as follows: 436 coronary vessels as normal, 175 as non-obstructive CAD, 179 as stable obstructive CAD and 74 as unstable obstructive CAD. Multilevel ordinal regression analysis was performed to study associations between baseline clinical variables and angiographic findings. Hs-CRP contributed significantly to the multivariate model after adjustment for age, gender, smoking, lipids and blood pressure. In 8139 subjects, 201 (2.5%) first coronary events occurred during follow up. Cox survival analysis showed age- and sex-adjusted hazard ratios for hs-CRP 1-3 and >3mg/L of, respectively, 1.26 (95% CI 0.67-2.40) and 3.16 (95% CI 1.26-3.16), relative to hs-CRP <1mg/L.


CONCLUSIONS
In the prospective PREVEND study of subjects without previous documented CAD, hs-CRP levels at baseline were associated with angiographic characteristics and clinical consequences of plaque instability during follow up. This observation supports the concept that hs-CRP significantly contributes to coronary atherogenesis.
Geluk
Christiane A
CA
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands. Electronic address: c.a.geluk@thorax.umcg.nl.
Post
Wendy J
WJ
Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands.
Hillege
Hans L
HL
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands.
Tio
René A
RA
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands.
Tijssen
Jan G P
JGP
Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
van Dijk
René B
RB
Department of Cardiology, Martini Hospital Groningen, The Netherlands.
Arnold Dijk
W
W
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands.
Bakker
Stephan J L
SJL
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands.
de Jong
Paul E
PE
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands.
van Gilst
Wiek H
WH
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands; Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands.
Zijlstra
Felix
F
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands.
D000368:Aged; D002097:C-Reactive Protein / Q000502:physiology*; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology* / Q000503:physiopathology*; D054059:Coronary Occlusion / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D016016:Proportional Hazards Models; D011446:Prospective Studies
D002097:C-Reactive Protein