title: Increased hsCRP is associated with higher risk of aortic valve replacement in patients with aortic stenosis.
abstract: Objective To investigate relations between inflammation and aortic valve stenosis (AS) by measuring high-sensitivity C-reactive protein, at baseline (hsCRP0) and after 1 year (hsCRP1) and exploring associations with aortic valve replacement (AVR). Design We examined 1423 patients from the Simvastatin and Ezetimibe in Aortic Stenosis study. Results During first year of treatment, hsCRP was reduced both in patients later receiving AVR (2.3 [0.9-4.9] to 1.8 [0.8-5.4] mg/l, p < 0.001) and not receiving AVR (1.90 [0.90-4.10] to 1.3 [0.6-2.9] mg/l, p < 0.001). In Cox-regression analyses, hsCRP1 predicted later AVR (HR = 1.17, p < 0.001) independently of hsCRP0 (HR = 0.96, p = 0.33), aortic valve area (AVA) and other risk factors. A higher rate of AVR was observed in the group with high hsCRP0 and an increase during the first year (AVRhighCRP0CRP1inc = 47.3% versus AVRhighCRP0CRP1dec = 27.5%, p < 0.01). The prognostic benefit of a 1-year reduction in hsCRP was larger in patients with high versus low hsCRP0 eliminating the difference in incidence of AVR between high versus low hsCRP0 (AVRhighCRP0CRP1dec = 27.5% versus AVRlowCRP0CRP1dec = 25.8%, p = 0.66) in patients with reduced hsCRP during the first year. Conclusions High hsCRP1 or an increase in hsCRP during the first year of follow-up predicted later AVR independently of AVA, age, gender and other risk factors, although no significant improvement in C-statistics was observed.
authors.affiliation: a Department of Cardiology , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark ;
authors.forename: Adam
authors.initials: A
authors.lastname: Blyme
authors.affiliation: a Department of Cardiology , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark ;
authors.forename: Camilla
authors.initials: C
authors.lastname: Asferg
authors.affiliation: b Department of Cardiology , Bispebjerg Hospital, University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Olav W
authors.initials: OW
authors.lastname: Nielsen
authors.affiliation: c Research Unit, Skelelfteå , Institution of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden ;
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
authors.affiliation: d Heart Center Bad Krozingen , Bad Krozingen , Germany ;
authors.forename: Christa
authors.initials: C
authors.lastname: Gohlke-Bärwolf
authors.affiliation: e Oslo University Hospital, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Section Cardiology Intervention , Unit Ullevål , Oslo , Norway ;
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.affiliation: f Centre for Individualized Medicine in Arterial Diseases (CIMA) , Odense University Hospital, University of Southern Denmark , Denmark ;|g Medical Research Council Unit on Hypertension and Cardiovascular Disease; Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom, South Africa.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D002097:C-Reactive Protein / Q000032:analysis*; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume
chemical_list: D002097:C-Reactive Protein
keywords: Aortic stenosis; high-sensitive C-reactive protein; in treatment measurement; inflammation