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Abstract

Objective

An interleukin-beta antagonist reduces the risk of subsequent cardiovascular events in coronary patients with high-sensitivity C-reactive protein (hs-CRP) ≥2 mg/L. It remains to be defined how large the coronary population at inflammatory risk is, and what the predictors of elevated risk are.

Methods

A cross-sectional study investigated the proportion of patients with elevated hs-CRP (i.e. ≥2 mg/L) and the respective demographic and clinical predictors in 971 patients without concomitant inflammatory diseases who had been hospitalized with myocardial infarction (80%) and/or a revascularization procedure. Data were collected from hospital records, a self-report questionnaire and a clinical examination with blood samples.

Results

After 2–36 month follow-up, 39% (n = 378) had hs-CRP ≥ 2 mg/L, among whom 64% (n = 243) had low-density lipoprotein cholesterol (LDL-C) ≥1.8 mmol/L and 47% (n = 176) used a low-intensity statin regime. Only 24% had both LDL and hs-CRP at target range, 27% had elevation of both, whereas 12% had hs-CRP ≥ 2 mg/L and LDL-C < 1.8 mmol/L. Somatic comorbidity (odds ratio (OR) 1.3/1.0 point on the Charlson score), ≥1 previous coronary event (OR 2.4), smoking (OR 2.2), higher body mass index (OR 1.2/1.0 kg/m²), high LDL-C (OR 1.4/1.0 mmol/L) and higher anxiety scores (OR 1.1/1.0 point increase on the Hospital Anxiety and Depression Scale-Anxiety subscale score) were significantly associated with hs-CRP ≥2 mg/L in adjusted analyses.

Conclusions

Elevated hs-CRP was frequently observed after a coronary event and associated with unfavourable LDL-C and unhealthy lifestyles and psychosocial distress. Intensified statin therapy and strategies to target these modifiable factors are the encouraged first steps to reduce inflammation and improve LDL-C in these patients.

Keywords

High-sensitivity C-reactive protein prevalence predictors secondary prevention coronary heart disease low-density lipoprotein cholesterol statin therapy risk factor control demographic factors psychosocial factors

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References

Emerging Risk Factors C Kaptoge

Di Angelantonio

et al.

C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: An individual participant meta-analysis. Lancet 2010; 375: 132–140.

Ridker

Cannon

Morrow

et al.

C-reactive protein levels and outcomes after statin therapy. N Engl J Med 2005; 352: 20–28.

Piepoli

Hoes

Agewall

et al.

2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016; 37: 2315–2381.

McMurray

Kjekshus

Gullestad

et al.

Effects of statin therapy according to plasma high-sensitivity C-reactive protein concentration in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA): A retrospective analysis. Circulation 2009; 120: 2188–2196.

Bohula

Giugliano

Cannon

et al.

Achievement of dual low-density lipoprotein cholesterol and high-sensitivity C-reactive protein targets more frequent with the addition of ezetimibe to simvastatin and associated with better outcomes in IMPROVE-IT. Circulation 2015; 132: 1224–1233.

Cannon

Braunwald

McCabe

et al.

Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–1504.

Libby

Ridker

Hansson

. Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: From pathophysiology to practice. J Am Coll Cardiol 2009; 54: 2129–2138.

Ross

. Atherosclerosis – an inflammatory disease. N Engl J Med 1999; 340: 115–126.

Ridker

Everett

Thuren

et al.

Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med 2017; 377: 1119–1131.

10.

Sabatine

Morrow

Jablonski

et al.

Prognostic significance of the Centers for Disease Control/American Heart Association high-sensitivity C-reactive protein cut points for cardiovascular and other outcomes in patients with stable coronary artery disease. Circulation 2007; 115: 1528–1536.

11.

Munkhaugen

Sverre

Peersen

et al.

The role of medical and psychosocial factors for unfavourable coronary risk factor control. Scand Cardiovasc J 2016; 50: 1–8.

12.

Statistics Norway, https://www.ssb.no/befolkning/statistikker/flytting (25 May 2016, accessed 25 April 2017) and http://cvdnor.b.uib.no/files/2013/08/CVDNOR-Data-and-Quality-Report1.pdf (2013, accessed 25 May 2016).

13.

Peersen

Munkhaugen

Gullestad

et al.

Reproducibility of an extensive self-report questionnaire used in secondary coronary prevention. Scand J Public Health 2017; 45: 269–276.

14.

Stone

Robinson

Lichtenstein

et al.

2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Circulation 2014; 129(25 Suppl. 2): S1–S45.

15.

Kones

. Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease – a perspective. Drug Des Devel Ther 2010; 4: 383–413.

16.

Nissen

Tuzcu

Schoenhagen

et al.

Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease. N Engl J Med 2005; 352: 29–38.

17.

Ridker

. Residual inflammatory risk: Addressing the obverse side of the atherosclerosis prevention coin. Eur Heart J 2016; 37: 1720–1722.

18.

Chirinos

Gurubhagavatula

Teff

et al.

CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med 2014; 370: 2265–2275.

19.

Estruch

. Anti-inflammatory effects of the Mediterranean diet: The experience of the PREDIMED study. Proc Nutr Soc 2010; 69: 333–340.

20.

Anderson

Sharp

Norton

et al.

Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2017; 6: CD007130–CD007130.

21.

Celano

Beale

Beach

et al.

Associations between psychological constructs and cardiac biomarkers after acute coronary syndrome. Psychosom Med 2017; 79: 318–326.

22.

Kumar

Nayak

. Psychological sequelae of myocardial infarction. Biomed Pharmacother 2017; 95: 487–496.

23.

Gimeno

Kivimaki

Brunner

et al.

Associations of C-reactive protein and interleukin-6 with cognitive symptoms of depression: 12-year follow-up of the Whitehall II study. Psychol Med 2009; 39: 413–423.

24.

Wium-Andersen

Orsted

Nielsen

et al.

Elevated C-reactive protein levels, psychological distress, and depression in 73,131 individuals. JAMA Psychiatry 2013; 70: 176–184.

25.

Almeida

Norman

Hankey

et al.

The association between C-reactive protein concentration and depression in later life is due to poor physical health: Results from the Health in Men Study (HIMS). Psychol Med 2007; 37: 1775–1786.

26.

Bielas H, Meister-Langraf RE, Schmid JP, et al. Acute stress disorder and C-reactive protein in patients with acute myocardial infarction. Eur J Prev Cardiol. 2018; 25: 298–305.

27.

Wirtz

von Kanel

. Psychological stress, inflammation, and coronary heart disease. Curr Cardiol Rep 2017; 19: 111–111.

28.

Mommersteeg

Meeuwis

Denollet

et al.

C-reactive protein and fibrinogen in non-obstructive coronary artery disease as related to depressive symptoms and anxiety. J Psychosom Res 2014; 77: 426–429.

29.

Heldal M and Pedersen TR. Hjerteforum No. 1/ 2017 / vol. 30. Available at: http://legeforeningen.no/Fagmed/Norsk-cardiologisk-selskap/Hjerteforum1/b-2017/bHjerteforum-nr-1-2017/.

30.

Sabatine

Giugliano

Keech

et al.

Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017; 376: 1713–1722.

31.

Canakinumab (Ilaris): Common drug review. Ottawa: Canadian Agency for Drugs and Technologies in Health, 2016, https://www.ncbi.nlm.nih.gov/books/NBK409908/ (accessed 15 November 2017).

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The prevalence and predictors of elevated C-reactive protein after a coronary heart disease event

Abstract

Objective

Methods

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material