The prognostic value of high sensitivity C-reactive protein in a multi-ethnic population after >10 years of follow-up

The Multi-Ethnic Study of Atherosclerosis (MESA)

Miguel Cainzos-Achirica, Michael D. Miedema, John W. McEvoy, Mary Cushman, Zeina Dardari, Philip Greenland, Khurram Nasir, Matthew J. Budoff, Mouaz H. Al-Mallah, Joseph Yeboah, Roger S Blumenthal, Josep Comin-Colet, Michael Blaha

Research output: Contribution to journalArticle

Abstract

Background: The prognostic value of hsCRP in contemporary multi-ethnic populations is unclear, particularly in statin users. The aim of this study was to characterize the prognostic utility of hsCRP for atherosclerotic CVD (ASCVD) risk prediction in a multi-ethnic population including non-users and users of statins followed for >13 years. Associations with heart failure (HF), atrial fibrillation (AF), venous thromboembolism (VTE), cancer, and all-cause death were also examined. Methods and results: We evaluated 6757 participants from the Multi-Ethnic Study of Atherosclerosis (MESA; 1002 using statins at baseline), median follow-up 13.2 years. Higher levels of hsCRP were associated with a higher risk of all study endpoints in the unadjusted Cox Proportional Hazards regression analyses, except AF. Among non-users of statins, hsCRP only remained associated with VTE after adjusting for ASCVD risk factors, and did not improve risk prediction. Among users of statins, hsCRP did not improve ASCVD risk prediction either, although it was strongly associated with incident HF (HR for hsCRP ≥ 2 vs <2 mg/L 3.99; 95% CI 2.02, 7.90) and all-cause death (HR 1.52; 95% CI 1.11, 2.08) in multivariable analyses, and hsCRP significantly improved prediction of HF (area under the curve [AUC] basic model 0.741, AUC basic + hsCRP 0.788). Conclusions: The utility of hsCRP for ASCVD prediction was modest. On the other hand, hsCRP was associated with incident VTE in statin non-users, and all-cause mortality and HF in statin users. In the latter, hsCRP improved the prediction of incident HF events. This finding should be replicated in larger cohorts.

Original languageEnglish (US)
Pages (from-to)158-164
Number of pages7
JournalInternational Journal of Cardiology
Volume264
DOIs
StatePublished - Aug 1 2018

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
C-Reactive Protein
Atherosclerosis
Heart Failure
Venous Thromboembolism
Population
Atrial Fibrillation
Area Under Curve
Cause of Death
Regression Analysis
Mortality

Keywords

  • C-reactive protein
  • Cardiovascular disease
  • Heart failure
  • Inflammation
  • Prediction
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The prognostic value of high sensitivity C-reactive protein in a multi-ethnic population after >10 years of follow-up : The Multi-Ethnic Study of Atherosclerosis (MESA). / Cainzos-Achirica, Miguel; Miedema, Michael D.; McEvoy, John W.; Cushman, Mary; Dardari, Zeina; Greenland, Philip; Nasir, Khurram; Budoff, Matthew J.; Al-Mallah, Mouaz H.; Yeboah, Joseph; Blumenthal, Roger S; Comin-Colet, Josep; Blaha, Michael.

In: International Journal of Cardiology, Vol. 264, 01.08.2018, p. 158-164.

Research output: Contribution to journalArticle

Cainzos-Achirica, Miguel ; Miedema, Michael D. ; McEvoy, John W. ; Cushman, Mary ; Dardari, Zeina ; Greenland, Philip ; Nasir, Khurram ; Budoff, Matthew J. ; Al-Mallah, Mouaz H. ; Yeboah, Joseph ; Blumenthal, Roger S ; Comin-Colet, Josep ; Blaha, Michael. / The prognostic value of high sensitivity C-reactive protein in a multi-ethnic population after >10 years of follow-up : The Multi-Ethnic Study of Atherosclerosis (MESA). In: International Journal of Cardiology. 2018 ; Vol. 264. pp. 158-164.
@article{c84e932fb8dd4cccb0aa6a4ea2119a81,
title = "The prognostic value of high sensitivity C-reactive protein in a multi-ethnic population after >10 years of follow-up: The Multi-Ethnic Study of Atherosclerosis (MESA)",
abstract = "Background: The prognostic value of hsCRP in contemporary multi-ethnic populations is unclear, particularly in statin users. The aim of this study was to characterize the prognostic utility of hsCRP for atherosclerotic CVD (ASCVD) risk prediction in a multi-ethnic population including non-users and users of statins followed for >13 years. Associations with heart failure (HF), atrial fibrillation (AF), venous thromboembolism (VTE), cancer, and all-cause death were also examined. Methods and results: We evaluated 6757 participants from the Multi-Ethnic Study of Atherosclerosis (MESA; 1002 using statins at baseline), median follow-up 13.2 years. Higher levels of hsCRP were associated with a higher risk of all study endpoints in the unadjusted Cox Proportional Hazards regression analyses, except AF. Among non-users of statins, hsCRP only remained associated with VTE after adjusting for ASCVD risk factors, and did not improve risk prediction. Among users of statins, hsCRP did not improve ASCVD risk prediction either, although it was strongly associated with incident HF (HR for hsCRP ≥ 2 vs <2 mg/L 3.99; 95{\%} CI 2.02, 7.90) and all-cause death (HR 1.52; 95{\%} CI 1.11, 2.08) in multivariable analyses, and hsCRP significantly improved prediction of HF (area under the curve [AUC] basic model 0.741, AUC basic + hsCRP 0.788). Conclusions: The utility of hsCRP for ASCVD prediction was modest. On the other hand, hsCRP was associated with incident VTE in statin non-users, and all-cause mortality and HF in statin users. In the latter, hsCRP improved the prediction of incident HF events. This finding should be replicated in larger cohorts.",
keywords = "C-reactive protein, Cardiovascular disease, Heart failure, Inflammation, Prediction, Prognosis",
author = "Miguel Cainzos-Achirica and Miedema, {Michael D.} and McEvoy, {John W.} and Mary Cushman and Zeina Dardari and Philip Greenland and Khurram Nasir and Budoff, {Matthew J.} and Al-Mallah, {Mouaz H.} and Joseph Yeboah and Blumenthal, {Roger S} and Josep Comin-Colet and Michael Blaha",
year = "2018",
month = "8",
day = "1",
doi = "10.1016/j.ijcard.2018.02.027",
language = "English (US)",
volume = "264",
pages = "158--164",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - The prognostic value of high sensitivity C-reactive protein in a multi-ethnic population after >10 years of follow-up

T2 - The Multi-Ethnic Study of Atherosclerosis (MESA)

AU - Cainzos-Achirica, Miguel

AU - Miedema, Michael D.

AU - McEvoy, John W.

AU - Cushman, Mary

AU - Dardari, Zeina

AU - Greenland, Philip

AU - Nasir, Khurram

AU - Budoff, Matthew J.

AU - Al-Mallah, Mouaz H.

AU - Yeboah, Joseph

AU - Blumenthal, Roger S

AU - Comin-Colet, Josep

AU - Blaha, Michael

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: The prognostic value of hsCRP in contemporary multi-ethnic populations is unclear, particularly in statin users. The aim of this study was to characterize the prognostic utility of hsCRP for atherosclerotic CVD (ASCVD) risk prediction in a multi-ethnic population including non-users and users of statins followed for >13 years. Associations with heart failure (HF), atrial fibrillation (AF), venous thromboembolism (VTE), cancer, and all-cause death were also examined. Methods and results: We evaluated 6757 participants from the Multi-Ethnic Study of Atherosclerosis (MESA; 1002 using statins at baseline), median follow-up 13.2 years. Higher levels of hsCRP were associated with a higher risk of all study endpoints in the unadjusted Cox Proportional Hazards regression analyses, except AF. Among non-users of statins, hsCRP only remained associated with VTE after adjusting for ASCVD risk factors, and did not improve risk prediction. Among users of statins, hsCRP did not improve ASCVD risk prediction either, although it was strongly associated with incident HF (HR for hsCRP ≥ 2 vs <2 mg/L 3.99; 95% CI 2.02, 7.90) and all-cause death (HR 1.52; 95% CI 1.11, 2.08) in multivariable analyses, and hsCRP significantly improved prediction of HF (area under the curve [AUC] basic model 0.741, AUC basic + hsCRP 0.788). Conclusions: The utility of hsCRP for ASCVD prediction was modest. On the other hand, hsCRP was associated with incident VTE in statin non-users, and all-cause mortality and HF in statin users. In the latter, hsCRP improved the prediction of incident HF events. This finding should be replicated in larger cohorts.

AB - Background: The prognostic value of hsCRP in contemporary multi-ethnic populations is unclear, particularly in statin users. The aim of this study was to characterize the prognostic utility of hsCRP for atherosclerotic CVD (ASCVD) risk prediction in a multi-ethnic population including non-users and users of statins followed for >13 years. Associations with heart failure (HF), atrial fibrillation (AF), venous thromboembolism (VTE), cancer, and all-cause death were also examined. Methods and results: We evaluated 6757 participants from the Multi-Ethnic Study of Atherosclerosis (MESA; 1002 using statins at baseline), median follow-up 13.2 years. Higher levels of hsCRP were associated with a higher risk of all study endpoints in the unadjusted Cox Proportional Hazards regression analyses, except AF. Among non-users of statins, hsCRP only remained associated with VTE after adjusting for ASCVD risk factors, and did not improve risk prediction. Among users of statins, hsCRP did not improve ASCVD risk prediction either, although it was strongly associated with incident HF (HR for hsCRP ≥ 2 vs <2 mg/L 3.99; 95% CI 2.02, 7.90) and all-cause death (HR 1.52; 95% CI 1.11, 2.08) in multivariable analyses, and hsCRP significantly improved prediction of HF (area under the curve [AUC] basic model 0.741, AUC basic + hsCRP 0.788). Conclusions: The utility of hsCRP for ASCVD prediction was modest. On the other hand, hsCRP was associated with incident VTE in statin non-users, and all-cause mortality and HF in statin users. In the latter, hsCRP improved the prediction of incident HF events. This finding should be replicated in larger cohorts.

KW - C-reactive protein

KW - Cardiovascular disease

KW - Heart failure

KW - Inflammation

KW - Prediction

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=85047004934&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047004934&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2018.02.027

DO - 10.1016/j.ijcard.2018.02.027

M3 - Article

VL - 264

SP - 158

EP - 164

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -