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Published on: January 28, 2020
Prognostic markers in young patients with premature coronary heart disease
Janine E van Loon1, Moniek P M de Maat, Jaap W Deckers
1Department of Haematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Insights
In young patients with premature heart disease, high levels of C-reactive protein (CRP) and fibrinogen predict recurrent events and mortality. These inflammatory markers are key prognostic indicators for cardiovascular risk in younger adults.
Area of Science:
- Cardiology
- Biomarkers
- Public Health
Background:
- Premature coronary heart disease (CHD) affects young individuals, necessitating identification of prognostic factors beyond traditional cardiovascular risks.
- Understanding survival implications of inflammatory and prothrombotic markers is crucial for risk stratification in this population.
Purpose of the Study:
- To evaluate the prognostic value of cardiovascular, inflammatory, and prothrombotic risk factors in young patients diagnosed with premature CHD.
- To assess the association of these factors with survival and recurrent adverse cardiovascular events.
Main Methods:
- A cohort of 353 young patients (men ≤45, women ≤55 years) with a first cardiac event was followed for a median of 4.2 years.
- Plasma levels of C-reactive protein (CRP), von Willebrand Factor (VWF), and fibrinogen were measured post-event to assess inflammatory and prothrombotic status.
- Cox regression analyses were used to determine the relationship between risk factors and outcomes including all-cause mortality, recurrent cardiac events, and any recurrent event.
Main Results:
- During follow-up (1483 person-years), 3% died, 12% experienced a recurrent cardiac event, and 15% had any recurrent event.
- Elevated C-reactive protein (CRP) levels were associated with an increased risk of any recurrent event (HR 1.28).
- Both high CRP and high fibrinogen levels were significantly associated with all-cause mortality (HRs 5.00 and 5.04, respectively) when above the 50th percentile.
Conclusions:
- Approximately 15% of young patients with premature CHD experience recurrent events or mortality within 4.2 years.
- High CRP levels independently predict recurrent events and all-cause mortality in young patients with CHD.
- Elevated fibrinogen levels are also associated with increased all-cause mortality in this high-risk young cohort.
Objectives:
To evaluate the survival and prognostic implications of cardiovascular, inflammatory and prothrombotic risk factors in young patients with premature coronary heart disease (CHD).
Methods:
Follow-up data were obtained from 353 young patients with a first cardiac event (men ≤45 years and women ≤55 years). Baseline characteristics on traditional risk factors were collected at the time of the first event, and plasma levels of C-reactive protein (CRP), von Willebrand Factor (VWF), and fibrinogen were measured one to three months after the first event to exclude an acute phase response. We performed age and sex adjusted Cox regression analyses to assess the relationship between these factors and recurrent events with three different endpoints: all cause mortality, recurrent cardiac event (myocardial infarction or revascularisation procedure), and any recurrent event (cardiac event, cerebrovascular event or all cause mortality).
Results:
During a total follow-up time of 1483 person years (mean 4.2 years), 11 patients died (3%), 42 patients had a recurrent cardiac event (12%), and 53 patients had any recurrent event (15%). CRP was associated with an increased risk of any recurrent event (HR 1.28[95% CI = 1.02-1.59] per unit increase in lnCRP). Also, both CRP (5.00[1.04-24.04]) and fibrinogen (5.04[1.05-24.23]) were associated with all cause mortality when levels were above the 50th percentile.
Conclusions:
Fifteen percent of young patients with a first cardiac event have a recurrent event or die within a median follow-up of 4.2 years. In these young patients we have shown that, independently of cardiovascular risk factors, high CRP levels contribute to the risk of recurrent events, including all cause mortality, and high fibrinogen levels are associated with all cause mortality.
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