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August 30, 2005CirculationOpen Access

C-Reactive Protein in Heart Failure

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Why the study?

Does baseline C-reactive protein predict mortality and morbidity in patients with heart failure?

Population

Patients with New York Heart Association class II, III, or IV heart failure randomized in the Val-HeFT trial

Comparison

Valsartan vs Placebo

Design

Cohort, randomly assigned to valsartan or placebo

Key result

Higher C-reactive protein levels are independently associated with increased risk of mortality (HR 1.51) and morbidity (HR 1.53) in heart failure patients.

Authors

IAInder S. AnandRLRoberto LatiniVFViorel G. Florea

Discussion

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Overview

Elevated CRP may refine heart failure risk stratification beyond BNP; supports observational prognostic data but leaves causal role and therapeutic targeting open.

Key Points

  • Assess the prognostic value of C-reactive protein (CRP) in heart failure patients and the effects of valsartan on CRP levels.
  • Compared patient characteristics with baseline CRP levels above and below the median.
  • Used univariable and multivariable Cox proportional hazards regression models to analyze CRP's relationship to mortality and morbidity.
  • Tested interactions based on ACE inhibitor use regarding CRP changes after treatment with valsartan or placebo.
  • Median plasma CRP was found to be 3.23 mg/L, indicating higher levels than the general population.
  • Patients with higher CRP levels exhibited more severe heart failure features.
  • The risk of mortality and morbidity increased with higher CRP quartiles, with significant hazard ratios reported for the highest quartiles.
  • Valsartan reduced CRP levels in patients who were not on ACE inhibitors after 12 months, while no significant change was noted in the placebo group.

Structured PICO

Does baseline C-reactive protein predict mortality and morbidity in patients with heart failure?

P
Population
Patients with New York Heart Association (NYHA) class II, III, or IV heart failure randomized in the Val-HeFT trial
I
Intervention
Valsartan
C
Comparator
Placebo
O
Outcome
Mortality and the first morbid event (defined as death, sudden death with resuscitation, hospitalization for HF, or administration of an intravenous inotropic or vasodilator drug for 4 hours or more without hospitalization)composite

Elevated baseline C-reactive protein is independently associated with increased mortality and morbidity in patients with heart failure, providing incremental prognostic value beyond BNP.

Limitations

  • Post hoc analysis of the Val-HeFT database
  • Difference in the effect of valsartan on CRP levels between the ACEI/non-ACEI subgroups was of borderline significance
  • Effect of improvement versus worsening of HF on CRP, independent of any drug effect, is difficult to assess
  • Model misspecification and overfitting might limit generalization of the results

Cite This Study

Anand et al. (2005) studied this question. Higher C-reactive protein levels are independently associated with increased risk of mortality (HR 1.51) and morbidity (HR 1.53) in heart failure patients.

synapsesocial.com/papers/6967e7600ea1492ff3f9b8dbhttps://doi.org/10.1161/circulationaha.104.508465
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