Key result
Elevated high-sensitivity C-reactive protein independently predicted a 4.5-fold increased risk of major adverse cardiovascular events compared to levels </L in patients without obstructive coronary artery disease.
Why the study?
Do elevated hs-CRP, diabetes mellitus, and hypertension predict the development of coronary artery spasm and long-term adverse outcomes in patients without obstructive CAD?
Observational (n=897)
Yes
Do elevated hs-CRP, diabetes mellitus, and hypertension predict the development of coronary artery spasm and long-term adverse outcomes in patients without obstructive CAD?
Elevated hs-CRP independently predicts long-term adverse cardiovascular outcomes in patients with suspected ischemic heart disease but no obstructive CAD, while diabetes and hypertension have complex, gender-specific interactions with hs-CRP in predicting coronary artery spasm.
Answers are grounded in this paper and cite their sources.
hs-CRP may aid CAS risk stratification; leaves open gender-specific diabetes-hypertension effects for prospective validation.
BACKGROUND: While hypertension is negatively associated with coronary artery spasm (CAS), scarce data are available on diabetes mellitus in relation to CAS. In addition, outcome prediction in patients with CAS is challenging due to the lack of appropriate biomarkers. Therefore, we sought to identify the roles that gender, high-sensitivity C-reactive protein (hs-CRP), diabetes mellitus and hypertension play in CAS development and prognosis. METHODOLOGY/PRINCIPAL FINDINGS: Patients (350 women and 547 men) undergoing diagnostic coronary angiography with or without proven CAS but without obstructive stenosis were evaluated at long-term follow-up (median 102 months). Diabetic women and diabetic men with low hs-CRP levels had a low and high risk of CAS (odds ratio [OR]: 0.16, 95% confidence interval [CI]: 0.01-1.88 and OR: 5.02, 95% CI: 1.03-24.54, respectively). The ORs of CAS in both women and men with the highest hs-CRP tertile (>3 mg/L) reduced from 4.41 to 1.45 and 2.98 to 1.52, respectively, if they had diabetes mellitus, and from 9.68 to 2.43 and 2.60 to 1.75, respectively, if they had hypertension. Hypertension had a more negative effect on CAS development in diabetic than non-diabetic women, which was not observed in men. The highest hs-CRP tertile was an independent predictor of adverse outcomes. Patients with the highest hs-CRP tertile had more coronary events than patients with the lowest hs-CRP tertitle (p = 0.021, log-rank test). CONCLUSIONS: Diabetes mellitus contributes to CAS development in men with low hs-CRP levels, but not in women. There are negative effects of diabetes mellitus and hypertension on CAS development in patients with high hs-CRP levels and especially in women. Elevated hs-CRP level independently predicts adverse outcomes.
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Hung et al. (2013) conducted an observational in Suspected ischemic heart disease without obstructive coronary artery disease (n=897). Elevated high-sensitivity C-reactive protein (>3 mg/L) vs. Lowest hs-CRP tertile (<1 mg/L) was evaluated on Major adverse cardiovascular events (composite of death, nonfatal myocardial infarction, and recurrent angina pectoris requiring repeat coronary angiography) (HR 4.535, 95% CI 1.287-15.980, p=0.019). Elevated high-sensitivity C-reactive protein independently predicted a 4.5-fold increased risk of major adverse cardiovascular events compared to levels </L in patients without obstructive coronary artery disease.
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