title: [Usefulness of high-sensitivity CRP increases during circadian rhythm for prediction of long-term cardiovascular events in patients with stable coronary artery disease].
abstract: OBJECTIVE
  We investigated the value of circadian variations in high-sensitivity C-reactive protein (hs-CRP) levels in prediction of long-term cardiovascular events (CVE) in patients with stable coronary artery disease (CAD).
  
  
  METHODS
  The study included 94 patients (70 men, 24 women; mean age 58 ± 9 years) with stable CAD. High-sensitivity CRP levels were measured at six-hour intervals, namely, morning (06:00), midday (12:00), evening (18:00), and midnight (24:00). Absolute change in hs-CRP (absolute ΔCRP) was calculated by subtracting the midday hs-CRP level from that of the morning. Relative change in hs-CRP (relative ΔCRP) was calculated by dividing absolute ΔCRP by the midday hs-CRP level. The patients were followed-up for a mean of 40.2 ± 8.0 months for monitoring of CVE.
  
  
  RESULTS
  During the follow-up period, CVE occurred in 24 patients (25.5%). Patients who developed CVE exhibited significantly higher serum creatinine, B-type natriuretic peptide, morning, evening, and midnight hs-CRP levels, absolute and relative ΔCRP, and left atrial end-diastolic diameter compared to patients without CVE (p<0.05). In logistic regression analysis, only left atrial end-diastolic diameter and absolute ΔCRP were independent predictors of CVE (OR=1.11, 95% CI 1.003-1.236, p=0.044 and OR=1.58, 95% CI 1.195-2.090, p=0.001, respectively). Every 1 mg/l increase in absolute ΔCRP represented a 58.1% increase in CVE risk. In receiver operating characteristics curve analysis, the cut-off value of 2 mg/l for absolute ΔCRP predicted CVE with 89.5% sensitivity and 84.2% specificity.
  
  
  CONCLUSIONS
  Our findings suggest that absolute circadian increases in hs-CRP levels may be helpful in predicting long-term CVEs in patients with stable CAD.
authors: Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey. mevlutkoc78@yahoo.com
authors: Mevlüt
authors: M
authors: Koç
authors: Durmuş Yıldıray
authors: DY
authors: Sahin
authors: Onur Kadir
authors: OK
authors: Uysal
authors: Osman
authors: O
authors: Karaarslan
authors: Esra
authors: E
authors: Dönmez
authors: Gülcan
authors: G
authors: Abalı
authors: Mustafa Kemal
authors: MK
authors: Batur
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002940:Circadian Rhythm; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein