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Published on: January 28, 2020
Inflammation and future risk of symptomatic heart failure in patients with stable coronary artery disease
Alon Eisen1, Michal Benderly2, Solomon Behar3
1Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel.
Insights
Elevated inflammatory markers like C-reactive protein (CRP), fibrinogen, and white blood cells (WBCs) are linked to a higher risk of heart failure (HF) in coronary artery disease (CAD) patients. Myocardial infarction partially mediates this association.
Area of Science:
- Cardiology
- Inflammation Research
- Public Health
Background:
- Heart failure (HF) poses a significant risk for patients with coronary artery disease (CAD).
- Inflammation is a known predictor of cardiovascular events in CAD patients.
- The association between inflammatory markers and incident HF in this population remains unclear.
Purpose of the Study:
- To investigate the link between inflammatory markers and the risk of developing HF in stable CAD patients.
- To explore the potential mediating role of myocardial infarction (MI) in this relationship.
Main Methods:
- Analysis of 2,945 patients with stable CAD, free of HF at baseline.
- Median follow-up duration of 7.9 years.
- Assessment of baseline inflammatory markers including C-reactive protein (CRP), fibrinogen, and white blood cells (WBCs).
Main Results:
- 17.2% of patients developed HF during follow-up.
- Higher baseline levels of CRP, fibrinogen, and WBCs were observed in patients who developed HF.
- Elevated inflammatory markers showed a dose-response relationship with incident HF, with hazard ratios ranging from 1.33 to 1.38 for the third tertiles.
- A combined inflammation score indicated a higher HF risk (HR 1.83 for the fifth quintile).
- Myocardial infarction partially mediated the association between inflammatory markers and subsequent HF.
Conclusions:
- Increased levels of CRP, fibrinogen, and WBCs are independently associated with a higher incidence of HF in patients with stable CAD.
- These findings highlight the prognostic value of inflammatory markers in predicting HF risk in this patient group.
Background:
Heart failure (HF) carries poor prognosis in coronary artery disease (CAD) patients despite advances in therapy. Inflammation predicts recurrent cardiovascular events in CAD patients. It is unknown whether increased levels of inflammatory markers are associated with incident HF in these patients.
Aim:
The aims of this study were to evaluate the association between inflammatory markers and future HF risk in patients with stable CAD and to explore possible mediation by myocardial infarction (MI).
Methods:
The study comprised 2,945 patients with stable CAD without HF at baseline during a median follow-up of 7.9 years. Inflammatory baseline markers were the basis of this study.
Results:
Heart failure was diagnosed in 508 patients (17.2%). Patients who developed HF were older and had more often previous MI, diabetes, hypertension, and peripheral vascular disease. Baseline levels of C-reactive protein (CRP), fibrinogen, and white blood cells (WBCs) were significantly higher in patients who developed HF compared with those who did not. Age-adjusted incident HF rates were related to elevated baseline inflammatory markers in a dose-response manner. Adjusting for multiple confounders, the HF hazard ratios were 1.38 (95% CI 1.11-1.72), 1.33 (95% CI 1.07-1.66), and 1.36 (95% CI 1.10-1.68) for the third tertiles of CRP, fibrinogen, and WBC levels, respectively. Hazard ratio for the fifth quintile of a combined "inflammation score" was 1.83 (95% CI 1.40-2.39). Mediation by MI preceding the HF onset during follow-up accounted for 10.4%, 10.8%, and 8.6% of the association of subsequent HF with CRP, fibrinogen, and WBC, respectively.
Conclusions:
Increased levels of CRP, fibrinogen, and WBC are independently related to the incidence of HF in patients with stable CAD.
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