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

被引:344
作者
Sabatine, Marc S.
Morrow, David A.
Jablonski, Kathleen A.
Rice, Madeline Murguia
Warnica, J. Wayne
Domanski, Michael J.
Hsia, Judith
Gersh, Bernard J.
Rifai, Nader
Ridker, Paul M.
Pfeffer, Marc A.
Braunwald, Eugene
机构
[1] Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Dept Med, Boston, MA 02115 USA
[3] George Washington Univ, Rockville, MD USA
[4] George Washington Univ, Washington, DC 20052 USA
[5] Univ Calgary, Dept Cardiac Sci, Calgary, AB T2N 1N4, Canada
[6] NHLBI, Bethesda, MD 20892 USA
[7] Mayo Clin & Mayo Fdn, Rochester, MN 55905 USA
[8] Childrens Hosp, Dept Lab Med & Pathol, Boston, MA 02115 USA
关键词
coronary disease; C-reactive protein; inflammation; risk factors;
D O I
10.1161/CIRCULATIONAHA.106.649939
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. Methods and 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.
引用
收藏
页码:1528 / 1536
页数:9
相关论文
共 39 条
  • [1] Relation of markers of inflammation (C-reactive protein, fibrinogen, von Willebrand factor, and leukocyte count) and statin therapy to long-term mortality in patients with angiographically proven coronary artery disease
    Bickel, C
    Rupprecht, HJ
    Blankenberg, S
    Espiniola-Klein, C
    Schlitt, A
    Rippin, G
    Hafner, G
    Treude, R
    Othman, H
    Hofmann, KP
    Meyer, J
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2002, 89 (08) : 901 - 908
  • [2] Braunwald E, 2004, NEW ENGL J MED, V351, P2058
  • [3] C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease
    Danesh, J
    Wheeler, JG
    Hirschfield, GM
    Eda, S
    Eiriksdottir, G
    Rumley, A
    Lowe, GDO
    Pepys, MB
    Gudnason, V
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (14) : 1387 - 1397
  • [4] Binding and internalization of C-reactive protein by fcgamma receptors on human aortic endothelial cells mediates biological effects
    Devaraj, S
    Du Clos, TW
    Jialal, I
    [J]. ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 2005, 25 (07) : 1359 - 1363
  • [5] A STUDY OF C-REACTIVE PROTEIN IN THE SERUM OF PATIENTS WITH CONGESTIVE HEART FAILURE
    ELSTER, SK
    BRAUNWALD, E
    WOOD, HF
    [J]. AMERICAN HEART JOURNAL, 1956, 51 (04) : 533 - 541
  • [6] C-reactive protein is an independent predictor of risk for the development of diabetes in the West of Scotland Coronary Prevention Study
    Freeman, DJ
    Norrie, J
    Caslake, MJ
    Gaw, A
    Ford, I
    Lowe, GDO
    O'Reilly, DS
    Packard, CJ
    Sattar, N
    [J]. DIABETES, 2002, 51 (05) : 1596 - 1600
  • [7] Predictors of congestive heart failure in the elderly: The cardiovascular health study
    Gottdiener, JS
    Arnold, AM
    Aurigemma, GP
    Polak, JF
    Tracy, RP
    Kitzman, DW
    Gardin, JM
    Rutledge, JE
    Boineau, RC
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 35 (06) : 1628 - 1637
  • [8] Haverkate F, 1997, LANCET, V349, P462, DOI 10.1016/S0140-6736(96)07591-5
  • [9] IRS-1-mediated inhibition of insulin receptor tyrosine kinase activity in TNF-alpha- and obesity-induced insulin resistance
    Hotamisligil, GS
    Peraldi, P
    Budavari, A
    Ellis, R
    White, MF
    Spiegelman, BM
    [J]. SCIENCE, 1996, 271 (5249) : 665 - 668
  • [10] Is type 2 diabetes mellitus a vascular condition?
    Hu, FB
    Stampfer, MJ
    [J]. ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 2003, 23 (10) : 1715 - 1716