Relationship between recurrently elevated hsCRP and adverse cardiovascular events among depressed patients in China:
Ying Wu1, Yuwei Mi1, Hanbin Cui2
1Department of Psychosomatic Medicine, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
Insights
Recurrent elevations in high-sensitivity C-reactive protein (hsCRP) are linked to increased cardiovascular events in depressed patients. Multipoint hsCRP measurements better predict cardiac risks than single measurements, highlighting persistent inflammation
Area of Science:
- Cardiovascular Medicine
- Psychiatry
- Inflammation Research
Background:
- Persistent inflammation is a known link between depression and cardiovascular diseases (CVDs).
- Multipoint inflammation assessments offer a more comprehensive understanding of an individual's inflammatory status than single measurements.
- Strategies for multipoint plasma high-sensitivity C-reactive protein (hsCRP) measurements are underexplored.
Purpose of the Study:
- To investigate the association between recurrent hsCRP elevations and cardiovascular events in patients diagnosed with depression.
- To evaluate the predictive value of longitudinal hsCRP patterns for recurrent cardiac events.
Main Methods:
- Retrospective cohort study analyzing 10-year medical records of 10,770 patients with depression.
- Classification into five groups based on hsCRP levels ( <3 mg/L, 3-8 mg/L, and ≥8 mg/L with 1, 2-3, or >3 measurements).
- Age-adjusted gamma frailty time-to-event models and Mean Cumulative Function (MCF) used to assess risks for chronic ischemic heart disease (CIHD), atrial fibrillation (AF)/arrhythmias, and major adverse cardiac events (MACE).
Main Results:
- Recurrent hsCRP elevations (≥8 mg/L) were significantly associated with increased risk of CIHD (HRs 1.70-1.88) and AF/arrhythmias (HR 1.83) compared to hsCRP <3 mg/L.
- MCFs indicated higher cumulative incidences of CIHD and MACE with increasing frequency of elevated hsCRP.
- The association between recurrent hsCRP elevations and cardiovascular events was stronger than observed in cross-sectional analyses.
Conclusions:
- Persistent inflammation, indicated by recurrent hsCRP elevations, is significantly associated with an increased risk of cardiovascular events in patients with depression.
- Longitudinal hsCRP patterns provide a more robust prediction of cardiovascular events compared to single measurements.
- The findings underscore the importance of monitoring inflammatory markers over time in depressed patients to manage cardiovascular risk.
Context:
Persistent inflammation has been considered a biological link between depression and cardiovascular diseases(CVDs). Multipoint assessments of inflammation provide a more reasonable understanding of an individual's inflammatory status compared to single-point measurements. However, few studies have established strategies to investigate multipoint measurements of plasma high-sensitivity C-reactive protein(hsCRP).
Aims/Objective/Hypothesis:
To elucidate the association between recurrent elevations in hsCRP and cardiovascular events among depressed patients.
Methods:
This retrospective cohort study analyzed medical records over a ten-year follow-up to evaluate the association between longitudinal hsCRP patterns and recurrent cardiovascular events in patients with depression. An age-adjusted gamma frailty time-to-event model was used to assess the risk for three primary outcomes: chronic ischemic heart disease (CIHD), atrial fibrillation (AF) and other arrhythmias, and major adverse cardiac events (MACE). The cumulative incidence of these recurrent events was estimated using the Mean Cumulative Function (MCF).
Results:
The study included 10,770 patients [7,428 (68.97%) females]. Patients were classified into five groups based on hsCRP levels: hsCRP < 3 mg/L (n = 4,209, 39.08%), 3-8 mg/L (n = 1,697, 15.76%), one measurement of hsCRP ≥ 8 mg/L (n = 3,007, 27.92%), two to three measurements of hsCRP ≥ 8 mg/L (n = 1,349, 12.53%), and >3 measurements of hsCRP ≥ 8 mg/L (n = 508, 4.72%). The MCFs for CIHD across the five groups were 1.156, 1.339, 1.417, 2.021, and 2.36, respectively. For AF and other arrhythmias, the corresponding MCFs were 0.796, 1.369, 1.008, 0.858, and 1.578, while for MACE, they were 0.084, 0.089, 0.134, 0.196, and 0.172. Compared with the reference group (hsCRP < 3 mg/L), the adjusted hazard ratios (HRs) for CIHD were 1.28 (P = 0.14), 1.19 (P = 0.17), 1.70 (P < 0.001), and 1.88 (P < 0.001) across the other four groups; for AF and other arrhythmias, they were 1.38 (P = 0.07), 1.00 (P = 0.99), 1.04 (P = 0.84), and 1.83 (P < 0.01); and for MACE, they were 0.85 (P = 0.65), 0.73 (P = 0.24), 1.21 (P = 0.49), and 1.28 (P = 0.40), respectively.
Conclusions:
The gamma frailty time-to-event model indicated a link between persistent inflammation and cardiac events. Recurrent hsCRP elevations were more strongly associated with cardiovascular events than those observed in cross-sectional analyses.
Trial Registration:
NCT06239246; ChiCTR2400089334.
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