Elevated C-reactive protein levels associated with increased risk of fatal and nonfatal coronary artery disease events
Tuesday, November 19, 2013. An article published in the December 2013 issue of the journal Arteriosclerosis, Thrombosis, and Vascular Biology reports findings from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort of an association between high C-reactive protein (CRP) levels and a greater risk of fatal as well as nonfatal coronary artery disease (CAD) events, including heart attack and angina.
The study includes 18,450 men and women whose average Framingham Risk Score was 12.8, which indicates a 12.8% average risk for a coronary artery disease event over a ten year period. Blood samples collected upon enrollment in EPIC between 1993 and 1997 were analyzed for serum C-reactive protein levels. Through March, 2008, there were 2,915 coronary artery disease events, 361 strokes and 657 peripheral artery disease events.
Among participants whose C-reactive protein levels were among the top 25% of participants at more than 3.3 milligrams per liter (mg/L), the adjusted risk of nonfatal coronary artery disease events was 61% higher than those whose levels were among the lowest 25%, and for fatal events, the risk was double that of the lowest group. The adjusted risk of nonfatal peripheral artery disease events among those whose CRP levels were highest was also more than double in comparison with the lowest group.
"Our observation that CRP levels are more strongly associated with fatal CAD events compared with nonfatal CAD events is underlined by the observation that CRP adds more discriminative power to the fatal compared with the nonfatal predictive risk model as demonstrated by the comparative predictive risk analyses," the authors note.
"First, inflammation in general can promote more serious atherothrombotic reactions comprising thrombosis, endothelial dysfunction, and vasoconstriction, thereby increasing the likelihood of a fatal outcome following plaque rupture," they explain. "Second, our findings are also compatible with the hypothesis that in the case of an acute coronary syndrome, CRP contributes to a more severe outcome by aggravating myocardial cell death and contributing to a wider area of tissue loss."
"This study lends further support to investigate the efficacy and safety of targeting inflammation per se for the prevention of cardiovascular events," they conclude.