High-sensitivity C-reactive protein elevation in patients with prior myocardial infarction in the United States - 30/10/18
, Anne S. Hellkamp, MS a, Puza P. Sharma, MBBS, MPH, PhD b, Tracy Y. Wang, MD, MHS, MSc a, Gregg C. Fonarow, MD c, Michael Pencina, PhD aAbstract |
Importance |
The extent to which levels of high-sensitivity C-reactive protein (hs-CRP), a known marker of increased cardiovascular risk, are elevated and are associated with standard cardiovascular risk factors in patients with a history of myocardial infarction (MI) is unknown.
Objectives |
To determine the pattern and determinants of the distribution of hs-CRP in those with a prior MI in the United States using a nationally representative sample.
Design and Participants |
Adults with hs-CRP data in the National Health and Nutrition Examination Surveys from 1999–2010.
Results |
Among 1296 individuals in our cohort, the median age was 65 years and the median hs-CRP level was 2.69 mg/L, measured an average of 7.1 years after the MI. Among these patients, 22% had hs-CRP levels of <1 mg/L, 61% had ≥2 mg/L, and 48% had ≥3 mg/L. Increasing hs-CRP was associated in a multivariable model with increasing body mass index (partial R2 [pR2] 0.113, P < .001), increasing non-high-density lipoprotein [HDL] (pR2 0.030, P < .001), increasing age (pR2 0.008, P = .017), and decreasing HDL (pR2 0.005, P = .046). Adjusted mean hs-CRP was also higher in women (3.6 vs 2.7 mg/L; P < .001), in people with hypertension (3.5 vs. 2.8, P = .030), and among smokers (4.2 vs 2.3 mg/L; P < .001), and lower in people with hyperlipidemia (2.8 vs. 3.5, P = .007). Standard cardiovascular risk factors accounted for only 22% of the variability in hs-CRP levels.
Conclusions and Relevance |
Among patients with prior MI, elevated hs-CRP is prevalent several years after the MI, and standard cardiovascular risk factors explain only a small proportion of hs-CRP variability. In light of emerging evidence on the importance of inflammation in the pathogenesis of cardiovascular disease, the high prevalence of elevated hs-CRP in patients with prior MI in the United States may have public health implications.
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| Disclosures: NJP: Ownership: Freedom Health, Inc; Physician Partners, LLC; RXAdvance, LLC; Florida Medical Associates, LLC. ASH: None. PPS: Employed by Novartis Pharmaceutical Corp. TYW: Research grants to the Duke Clinical Research Institute from AstraZeneca, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Gilead Sciences, Novartis, Pfizer, and Regeneron, as well as consulting or honoraria from Merck, Gilead, and Pfizer, Inc. GCF: Consulting: Amgen, Janssen, Novartis. MP: Grant from Novartis to Duke. |
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| Funding: Novartis Pharmaceutical Corporation. |
Vol 204
P. 151-155 - octobre 2018 Retour au numéro
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