Prognostic value of high sensitive C-reactive protein in subjects with silent myocardial ischemia

Area of Science:

• Cardiology
• Biomarkers
• Preventive Medicine

Background:

• Silent myocardial ischemia (SMI) is a significant risk factor for cardiovascular events.
• Prognostic markers for SMI are crucial for risk stratification in apparently healthy individuals.
• High-sensitive C-reactive protein (hs-CRP) is an inflammatory marker associated with cardiovascular risk.

Purpose of the Study:

• To determine the prognostic value of hs-CRP in individuals with SMI.
• To assess if hs-CRP can identify subgroups with different cardiovascular event risks among those with SMI.

Main Methods:

• A cohort of 678 healthy adults aged 55-75 without prior cardiovascular disease were enrolled.
• High-sensitive C-reactive protein (hs-CRP) levels and 48-hour ambulatory ECG monitoring were performed.
• The primary outcome was a composite of death and myocardial infarction, with a median follow-up of 76 months.

Main Results:

• Silent myocardial ischemia (SMI) was detected in 11.4% of participants.
• Subjects with SMI had a higher incidence of the combined endpoint (26%) compared to those without SMI (14%).
• Elevated hs-CRP (≥ 3.0 μg/mL) in SMI patients was associated with a significantly poorer prognosis (HR, 3.46; P = .001), while low hs-CRP (<3.0 μg/mL) indicated a similar risk to the general population (HR, 1.37; P = .54).

Conclusions:

• In apparently healthy individuals, silent myocardial ischemia (SMI) is associated with an increased risk of adverse cardiovascular events.
• High-sensitive C-reactive protein (hs-CRP) is a valuable prognostic marker in SMI.
• A low hs-CRP level (<3.0 μg/mL) effectively identifies a low-risk subgroup among individuals with SMI, suggesting a favorable prognosis despite the presence of ischemia.