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Trajectory of C-Reactive Protein and Incident Heart Failure in Black Adults: The Jackson Heart Study
Arsalan Hamid1, Wondwosen K Yimer2, Adebamike A Oshunbade3
1Department of Medicine (A.H., R.K.K., A.C., J.B., M.E.H.), University of Mississippi Medical Center, Jackson.
Insights
Rising inflammation, measured by high-sensitivity C-reactive protein (hsCRP), predicts heart failure (HF) hospitalization risk in Black adults. Temporal changes in hsCRP, not just baseline levels, are key indicators for HF risk.
Area of Science:
- Cardiology
- Inflammation Biomarkers
- Public Health
Background:
- High-sensitivity C-reactive protein (hsCRP) is a recognized marker of inflammation.
- Elevated hsCRP is linked to increased risk of cardiovascular events.
- Predictive value of hsCRP trajectory for heart failure (HF) hospitalization requires further investigation.
Purpose of the Study:
- To determine if baseline or changing hsCRP levels predict incident HF hospitalization.
- To investigate the association between hsCRP trajectory and HF risk in Black adults.
- To explore the role of hsCRP in HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).
Main Methods:
- Longitudinal study of 3920 Black adults from the Jackson Heart Study (JHS) with hsCRP measurements over 3 visits (2000-2013).
- Cox proportional hazards models and joint models were used to assess the association of baseline and trajectory hsCRP with incident HF hospitalization.
- Analysis included hsCRP changes between visits, categorizing participants into low-to-low, low-to-high, high-to-low, and high-to-high groups.
Main Results:
- Baseline hsCRP was not significantly associated with incident HF.
- An increasing hsCRP trajectory over time was associated with a higher risk of overall incident HF (aHR, 1.22) and HFpEF (aHR, 1.30).
- Changes in hsCRP from low-to-high and high-to-low levels were significantly associated with incident HF.
Conclusions:
- Baseline hsCRP levels do not predict incident HF, but a rising hsCRP trajectory does.
- Temporal changes in hsCRP are crucial for identifying individuals at increased risk for HF, particularly HFpEF.
- hsCRP trajectory may serve as a valuable risk marker for incident HFpEF in Black adults.
Background:
Increased hsCRP (high-sensitivity C-reactive protein), a marker of inflammation, is associated with incident cardiovascular events. We aim to determine whether the baseline or trajectory of hsCRP levels over time predicts incident heart failure (HF) hospitalization.
Methods:
JHS (Jackson Heart Study) participants' (n=3920 Black adults) hsCRP levels were measured over 3 visits (from 2000 to 2013). We assessed the association of hsCRP at baseline (visit 1) with incident HF hospitalization using Cox proportional hazards models. Furthermore, we assessed the association of the trajectory of hsCRP over repeated measurements (visits 1-3) with incident HF using joint models. Hazard ratios are reflective of an increase in hsCRP by 1 SD on a log2 scale. We also assessed the association of change in hsCRP between visit 1 and visit 3 with Cox proportional hazards models by grouping patients by low (<2 mg/L) and high (≥2 mg/L) hsCRP levels. The 4 groups were low-to-low (referent), low-to-high, high-to-low, and high-to-high.
Results:
Mean baseline age of participants was 54±13 years, and 63.8% were women. Over a median follow-up of 12 years, 308 (7.9%) participants were hospitalized with incident HF. Baseline hsCRP was not associated with incident HF (adjusted hazard ratio, 1.08 [95% CI, 0.96-1.22]). However, increasing hsCRP levels over repeated measures were associated with a higher risk of incident HF overall (adjusted hazard ratio, 1.22 [95% CI, 1.03-1.44]) and HF with preserved ejection fraction (adjusted hazard ratio, 1.30 [95% CI, 1.02-1.65]) but not HF with reduced ejection fraction (P>0.05). Furthermore, changes in hsCRP from low-to-high and high-to-low levels were associated with incident HF (P<0.05).
Conclusions:
While baseline hsCRP was not associated with incident HF, an increasing trajectory of hsCRP over time was associated with increased risk for incident HF (particularly HF with preserved ejection fraction). Temporal change in hsCRP may be an important marker of risk for incident HF with preserved ejection fraction in Black adults.
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