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C-Reactive Protein and Risk of Incident Heart Failure in Patients With Cardiovascular Disease
Pascal M Burger1, Stefan Koudstaal2, Arend Mosterd3
1Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
Insights
In patients with established cardiovascular disease (CVD), higher C-reactive protein (CRP) levels independently predict a greater risk of developing heart failure (HF). This finding highlights inflammation as a key factor in HF development.
Area of Science:
- Cardiology
- Inflammation Research
- Public Health
Background:
- Patients with established cardiovascular disease (CVD) face a high risk of developing heart failure (HF).
- Systemic inflammation is a potential contributing factor to the high incidence of HF in CVD patients.
Purpose of the Study:
- To investigate the association between C-reactive protein (CRP) levels and the risk of incident HF.
- To determine if CRP is an independent predictor of new-onset HF in individuals with pre-existing CVD.
Main Methods:
- Analysis of data from the prospective UCC-SMART cohort (n=8,089) with established CVD but no prevalent HF.
- Incident HF defined as first hospitalization for HF; assessed using Cox proportional hazards models.
- Adjustments made for established cardiovascular risk factors, medication use, and interim myocardial infarction.
Main Results:
- Higher CRP levels were independently associated with an increased risk of incident HF (HR per 1 mg/L: 1.10).
- Patients in the highest CRP quartile had more than double the risk of incident HF compared to the lowest quartile (HR: 2.22).
- The association was significant for both HF with reduced and preserved ejection fraction and remained consistent over time.
Conclusions:
- C-reactive protein (CRP) serves as an independent risk marker for incident heart failure (HF) in patients with established cardiovascular disease (CVD).
- These findings support further research into anti-inflammatory therapies to mitigate the burden of heart failure.
Background:
Patients with established cardiovascular disease (CVD) are at high risk of incident heart failure (HF), which may in part reflect the impact of systemic inflammation.
Objectives:
The goal of this study was to determine the association between C-reactive protein (CRP) and incident HF in patients with established CVD.
Methods:
Patients from the prospective UCC-SMART (Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease) cohort with established CVD, but without prevalent HF were included (n = 8,089). Incident HF was defined as a first hospitalization for HF. The association between baseline CRP and incident HF was assessed using Cox proportional hazards models adjusted for established risk factors (ie, age, sex, myocardial infarction, smoking, diabetes mellitus, body mass index, blood pressure, cholesterol, and kidney function).
Results:
During a median follow-up of 9.7 years (IQR 5.4-14.1 years), 810 incident HF cases were observed (incidence rate 1.01/100 person-years). Higher CRP was independently associated with an increased risk of incident HF: HR per 1 mg/L: 1.10 (95% CI: 1.07-1.13), and for last vs first CRP quartile: 2.22 (95% CI: 1.76-2.79). The association was significant for both HF with reduced (HR: 1.09; 95% CI: 1.04-1.14) and preserved ejection fraction (HR: 1.12; 95% CI: 1.07-1.18) (P for difference = 0.137). Additional adjustment for medication use and interim myocardial infarction did not attenuate the association, and the association remained consistent beyond 15 years after the CRP measurement.
Conclusions:
In patients with established CVD, CRP is an independent risk marker of incident HF. These data support ongoing trial efforts to assess whether anti-inflammatory agents can reduce the burden of HF.
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