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.
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.


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.
Sabatine
Marc S
MS
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. msabatine@partners.org
Morrow
David A
DA
Jablonski
Kathleen A
KA
Rice
Madeline Murguia
MM
Warnica
J Wayne
JW
Domanski
Michael J
MJ
Hsia
Judith
J
Gersh
Bernard J
BJ
Rifai
Nader
N
Ridker
Paul M
PM
Pfeffer
Marc A
MA
Braunwald
Eugene
E
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000401:mortality; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000592:standards*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012015:Reference Standards; D020521:Stroke / Q000453:epidemiology; D016019:Survival Analysis
D015415:Biomarkers; D007211:Indoles; C052035:trandolapril; D002097:C-Reactive Protein