C-reactive protein predicts future cardiovascular events in patients with carotid stenosis
Oliver Schlager1, Markus Exner, Wolfgang Mlekusch
1Department of Angiology, Medical University Vienna, Vienna, Austria.
Insights
Elevated high-sensitivity C-reactive protein (hs-CRP) indicates a higher risk of cardiovascular events in patients with atherosclerosis. This inflammation marker predicts adverse outcomes, independent of traditional risk factors.
Area of Science:
- Cardiovascular Medicine
- Inflammatory Diseases
- Medical Diagnostics
Background:
- Atherosclerosis is a systemic inflammatory condition.
- Previous research linked high-sensitivity C-reactive protein (hs-CRP) to short-term carotid atherosclerosis progression.
- The current study investigates hs-CRP's predictive value for midterm clinical outcomes.
Purpose of the Study:
- To determine if baseline hs-CRP levels predict midterm cardiovascular events in patients with carotid atherosclerosis.
- To assess the association between hs-CRP and the progression of carotid stenosis.
- To evaluate the independent predictive value of hs-CRP for adverse cardiovascular outcomes.
Main Methods:
- Prospective study of 1065 asymptomatic patients with carotid artery disease.
- Serial carotid ultrasound examinations at baseline and 6-9 months.
- Clinical follow-up for cardiovascular events (myocardial infarction, revascularization, stroke, death) over a median of 3 years.
Main Results:
- Carotid stenosis progression observed in 9% of patients.
- 381 cardiovascular events occurred in 27% of patients during follow-up.
- Elevated hs-CRP levels were significantly associated with both carotid stenosis progression (P<0.001) and future cardiovascular events (P<0.001).
- Adjusted hazard ratios for cardiovascular events increased with higher hs-CRP quintiles, independent of traditional risk factors and baseline stenosis severity.
Conclusions:
- Inflammation, as indicated by hs-CRP, is linked to the progression of atherosclerotic disease.
- Elevated hs-CRP levels identify patients at increased risk for adverse cardiovascular outcomes.
- hs-CRP serves as a valuable biomarker for predicting midterm clinical events in atherosclerosis patients.
Background And Purpose:
Atherosclerosis is a systemic inflammatory disease. We demonstrated previously that high-sensitivity C-reactive protein (hs-CRP) is associated with short-term progression of carotid atherosclerosis. We now investigated whether baseline levels of hs-CRP predict midterm clinical outcome in these patients.
Methods:
We prospectively studied 1065 of 1268 consecutive patients who were initially asymptomatic with respect to carotid artery disease and were investigated with serial carotid ultrasound examinations at baseline and after a 6- to 9-month interval. Patients were followed-up clinically for the occurrence of cardiovascular events, a composite of myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke, and death.
Results:
We recorded progression of carotid stenosis in 93 patients (9%) after 6 to 9 months, and 381 cardiovascular events in 337 patients (27%) during a median of 3 years of clinical follow-up (interquartile range, 2.5 to 3.5 years). The hs-CRP levels were significantly elevated in patients with progressive carotid stenosis (P<0.001), and hs-CRP was significantly associated with the occurrence of a first future cardiovascular event (P<0.001). Adjusted hazard ratios for a first cardiovascular event for increasing quintiles of hs-CRP were 1.41 (95% confidence interval, 0.92 to 2.17), 1.76 (95% confidence interval, 1.17 to 2.66), 2.22 (95% confidence interval, 1.48 to 3.32), and 2.41 (95% confidence interval, 1.61 to 3.60) as compared with the lowest quintile, respectively. This association was independent of traditional cardiovascular risk factors and the baseline degree of carotid stenosis.
Conclusions:
Inflammation was associated with morphological and clinical progression of atherosclerotic disease. Patients with elevated levels of hs-CRP exhibit an increased risk for adverse cardiovascular outcome attributable to clinical adverse events of progressive atherosclerotic disease.
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