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

• Published in: Circulation (New York, N.Y.) N.Y.), 2007-03, Vol.115 (12), p.1528-1536
• Main Authors: SABATINE, Marc S, MORROW, David A, PFEFFER, Marc A, BRAUNWALD, Eugene, JABLONSKI, Kathleen A, MURGUIA RICE, Madeline, WARNICA, J. Wayne, DOMANSKI, Michael J, HSIA, Judith, GERSH, Bernard J, RIFAI, Nader, RIDKER, Paul M
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Biomarkers; Blood and lymphatic vessels; C-Reactive Protein - analysis; Cardiology. Vascular system; Cardiovascular Diseases - mortality; Coronary Artery Bypass; Coronary Disease - blood; Coronary Disease - complications; Coronary Disease - drug therapy; Coronary Disease - epidemiology; Coronary heart disease; Diabetes Mellitus - epidemiology; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Heart; Humans; Indoles - therapeutic use; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Myocardial Infarction - epidemiology; Myocardial Infarction - surgery; Myocardial Infarction - therapy; Outcome Assessment (Health Care) - standards; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Reference Standards; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Stroke - epidemiology; Survival Analysis
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.649939

Data supporting the prognostic significance of high-sensitivity C-reactive protein (hs-CRP) are derived largely from individuals with no overt coronary artery disease or from patients with acute coronary syndromes. In contrast, the ability of hs-CRP to predict outcomes in patients with stable coronary artery disease and the prognostic significance of the Centers for Disease Control/American Heart Association hs-CRP cut points in such a population remain relatively unexplored. We measured hs-CRP in 3771 patients with stable coronary artery disease from the Prevention of Events With Angiotensin-Converting Enzyme Inhibition (PEACE) trial, a randomized placebo-controlled trial of the angiotensin-converting enzyme inhibitor trandolapril. Patients were followed up for a median of 4.8 years for cardiovascular death, myocardial infarction, or stroke, as well as new heart failure and diabetes. After adjustment for baseline characteristics and treatments, higher hs-CRP levels, even >1 mg/L, were associated with a significantly greater risk of cardiovascular death, myocardial infarction, or stroke (hs-CRP 1 to 3 mg/L: adjusted hazard ratio, 1.39; 95% CI, 1.06 to 1.81; P=0.016; hs-CRP >3 mg/L: adjusted hazard ratio, 1.52; 95% CI, 1.15 to 2.02; P=0.003). Similarly, elevated hs-CRP levels were an independent predictor of new heart failure (adjusted P