High-sensitivity C-reactive protein as a predictor of cardiovascular events in young patients following myocardial infarction

Abstract Introduction Young patients diagnosed with coronary artery disease (CAD) face an increased risk of recurrent cardiovascular events (CVE), leading to significant morbidity and mortality. Secondary prevention in CAD patients has been a cornerstone of cardiology, with remarkable advances in traditional risk factors (TRF) management like dyslipidemia, obesity and diabetes. Inflammation has long been associated with atherosclerosis, but can it be a real driving factor in the recurrence of CVE in young patients after a myocardial infarction? Objective To determine if high-sensitivity C-reactive protein (hsCRP) can improve the identification of recurrent CVE in patients 55 years at the time of the first event and with few TRF. Methods 473 non-diabetic patients with low density lipoprotein cholesterol (LDL-c) levels 100 mg/dl at first admission, who experienced a Myocardial Infarction (MI) 55 years (mean age 47.2±5.8 years) were prospectively followed for 7.3±6.0 years. Major adverse cardiovascular events (MACE) were recorded (MI; unstable angina; stroke; heart failure hospitalizations). HsCRP was measured, and considering the current evidence, the chosen cut-off was 0.3 mg/dL. Bivariate analysis was used to determine if elevated hsCRP levels and other TRF were associated with MACE. A multivariate analysis was performed to evaluate if hsCRP was an independent risk factor for MACE. Results During follow up, 164 patients had at least one CVE. Patients with hsCRP 0.3mg/dL (n=140) had a 51% event rate (n=72); the ones with hsCRP ≤0.3mg/dL had a 28% event rate (n=92). This difference met statistical significance (p0.001). After bivariate analysis, Lp(a) 30 mg/dl, younger age at the time of the 1st event, alcohol consumption 300g/week and glomerular filtration rate (GFR) 60ml/min/1.73m2 were also associated with MACE. The multivariate analysis confirmed hsCRP 0.3mg/dL as an independent risk factor for MACE (HR 1.449; p=0.021) as well as GFR 60 ml/min/1.73m2 (HR 2.013; p=0.035) and younger age at the time of 1st event (HR 1.033; p=0.024). Conclusion HsCRP may help identify individuals with a high risk of recurrent CVE. Anti-inflammatory therapies have consistently delivered promising results in cardiovascular endpoints but failed to achieve safety. Future studies are needed to understand if hsCRP guided anti-inflammatory therapies would benefit young patients with few TRF in secondary prevention.