Previous research has established that patients with CVD are at elevated risk of incident heart failure (HF), which may demonstrate systemic inflammation’s effect on the heart.

In a prospective, observational cohort study published in the Journal of American College of Cardiology, researchers sought to determine the correlation between C-reactive protein (CRP) and incident HF in patients with established CVD.

In this study, between September 1996 to January 2019 a total of 8,089 patients from the prospective UCC-SMART (Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease) cohort with established CVD but without prevalent HF were enrolled.

Patients had various forms of CVD but no history of HF hospitalization. The study’s primary outcome was incident HF, established via linkage to a nationwide hospitalization registry, utilizing the ICD-9 and ICD-10 codes. Patients were followed from the time of cohort entry until January 2019. The study also investigated the mediation of the CRP-HF association by interim myocardial infarction (MI), reverse causality, and the consistency of the association over time. Incident HF was described as a first hospitalization for HF.

The correlation between baseline CRP and incident HF was evaluated utilizing Cox proportional hazards models adjusted for established risk factors (i.e., age, gender, MI, smoking, diabetes mellitus, BMI, blood pressure, cholesterol, and kidney function).

The results revealed that during an average follow-up of 9.7 years (interquartile range 5.4-14.1 years), 810 incident HF cases were observed (incidence rate 1.01/100 person-years). Higher CRP was independently linked with a heightened risk of incident HF (hazard ratio [HR] per 1 mg/L: 1.10 [95% CI, 1.07-1.13], and for last versus first CRP quartile: 2.22 [95% CI, 1.76-2.79]. Additionally, elevated CRP levels were also significantly associated with an increased risk of HF with reduced ejection fraction (per 1 mg/L: HR 1.09; 95% CI, 1.04-1.14) and HF with preserved ejection fraction (HR 1.12; 95% CI, 1.07-1.18). Additional adjustments for medication use and interim MI did not decrease the correlation, and the correlation remained consistent beyond 15 years after the CRP measurement.

The authors indicated that higher CRP levels were significantly linked with an augmented long-term risk of incident HF, and the findings of this study emphasize the potential for anti-inflammatory therapies to alleviate this high risk, a proposition that requires further assessment through future trials.

The authors concluded, “In patients with established CVD, CRP is an independent risk marker of incident HF. These data support ongoing trial efforts to assess whether anti-inflammatory agents can reduce the burden of HF.”

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