Key result
Rising hsCRP trajectory, not baseline measurement, predicts incident HF hospitalization in African Americans.
Why the study?
Elevated hsCRP is associated with worse outcomes in HF, but whether baseline levels or longitudinal trajectory predict incident HF hospitalization was unknown.
Does the trajectory of hsCRP levels over time predict incident heart failure hospitalization in African Americans?
Cohort (n=4,203)
Does the trajectory of hsCRP levels over time predict incident heart failure hospitalization in African Americans?
p-value: p=<0.05
An increasing trajectory of hsCRP over time, rather than a single baseline measurement, is predictive of increased risk for incident heart failure hospitalization in African Americans.
Serial hsCRP trajectories may aid HF risk assessment in African Americans; hypothesis-generating and requires prospective validation.
Introduction: Elevation in the inflammatory marker high sensitivity C-reactive protein (hsCRP) is associated with worse outcomes in patients with heart failure (HF). We aimed to determine if baseline or trajectory of hsCRP levels over time predict incident HF hospitalization. Methods: Jackson Heart Study (JHS) participants’ (n=4203 African Americans) hsCRP levels were measured over 3 visits (visit 1: 2000 to 2004; visit 2: 2005 to 2008; visit 3: 2009 to 2013). We assessed the association of a single hsCRP level measurement at baseline (visit 1) with incident HF hospitalization using Cox proportional hazard models. Furthermore, we assessed the association of trajectory of hsCRP over repeated measurements (visit 1-3) with incident HF using a joint model, which incorporates estimated hsCRP from a linear mixed effects model into a Cox hazards model to predict incident HF hospitalization while incorporating trajectory of hsCRP over visits. All hazard ratios (HR) are presented as an increase in hsCRP by 1 standard deviation on a Log 2 scale. Results: At baseline, mean age of participants was 55±13 years, 63.4% were women, and mean hsCRP level was 0.5±0.7 mg/dl. Over a median follow-up of 12 years, 353 (8.4%) participants were hospitalized with incident HF. After adjustment for covariates, baseline hsCRP was not associated with increased risk of incident HF hospitalization (Table, p>0.05). However, increases in hsCRP levels on follow-up were associated with a significantly increased risk of incident HF hospitalization (Table, p<0.05). Conclusions: While an elevated hsCRP level at one time point may not be associated with incident HF, the increasing trajectory of change in hsCRP over time is predictive of increased risk for incident HF hospitalization in African Americans. These data support the role of increased inflammatory status in the development of heart failure.
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Hamid et al. (2020) conducted a cohort in Incident heart failure (n=4,203). High sensitivity C-reactive protein (hsCRP) trajectory vs. Baseline hsCRP was evaluated on Incident HF hospitalization (p=<0.05). An increasing trajectory of hsCRP over time, but not a single baseline measurement, was predictive of an increased risk for incident heart failure hospitalization in African Americans (p<0.05).
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