C-reactive protein and ischemia in users and nonusers of beta-blockers and statins: data from the Heart and Soul
Mary S Beattie1, Michael G Shlipak, Haiying Liu
1Department of Medicine, University of California, San Francisco, USA.
Insights
Elevated C-reactive protein (CRP) indicates a higher risk of inducible ischemia in stable coronary disease patients. This association is particularly strong in those not taking beta-blockers or statins.
Area of Science:
- Cardiology
- Inflammation Research
- Clinical Medicine
Background:
- Elevated C-reactive protein (CRP) is linked to increased coronary event risk.
- The relationship between inflammation and inducible ischemia in stable coronary disease remains unclear.
Purpose of the Study:
- To investigate the association between C-reactive protein (CRP) levels and exercise-induced ischemia in patients with stable coronary disease.
- To determine if this association is modified by the use of beta-blockers or statins.
Main Methods:
- The Heart and Soul Study recruited patients with known coronary disease.
- C-reactive protein (CRP) levels were measured and correlated with inducible ischemia identified via stress echocardiography.
- Logistic regression analysis was employed to assess the risk of ischemia associated with elevated CRP.
Main Results:
- Participants in the highest CRP category (>0.38 mg/dL) showed a significantly higher prevalence of inducible ischemia (75% vs. 45%).
- This association was pronounced in patients not using beta-blockers (93% vs. 42%) and statins (94% vs. 44%).
- No significant CRP-ischemia association was observed in patients treated with beta-blockers or statins.
Conclusions:
- Elevated C-reactive protein (CRP) levels are significantly associated with inducible ischemia in stable coronary disease.
- This inflammatory marker's predictive value for ischemia is most evident in patients not receiving beta-blocker or statin therapy.
Background:
Elevated levels of C-reactive protein (CRP) are associated with an increased risk of coronary events, but whether inflammation is associated with inducible ischemia in patients with stable coronary disease is unknown.
Methods And Results:
We recruited patients with known coronary disease from 2 VA Medical Centers and 1 University-based medical center for the Heart and Soul Study. We measured CRP levels in 118 participants who had exercise-induced ischemia and in 111 who did not have inducible ischemia, as determined by stress echocardiography. We used logistic regression to examine the risk of exercise-induced ischemia associated with elevated CRP. We found that 75% (39/52) of participants in the highest CRP category (>0.38 mg/dL) had inducible ischemia, compared with 45% (79/177) in the lower 4 categories combined (adjusted odds ratio 4.2; 95% confidence interval 1.6 to 11; P=0.004). However, this association differed in users and nonusers of beta-blockers and statins. Among 89 participants who did not use beta-blockers, 93% in the highest CRP category had exercise-induced ischemia, compared with 42% in the lower 4 categories (P=0.03). Among 67 participants who did not use statins, 94% in the highest CRP category had exercise-induced ischemia, compared with 44% in the lower 4 categories (P=0.009). We did not observe a significant association between CRP and ischemia among participants who were treated with either of these medications.
Conclusion:
Elevated CRP levels are associated with inducible ischemia in patients with stable coronary disease, particularly among those not treated with beta-blockers or statins.
More Related Videos
10:12A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Related Concept Videos
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:16Antianginal Drugs: Nitrates and β-Blockers
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow....
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Acute Coronary Syndrome III: Diagnostic Studies