005 Prognostic value of high sensibility C reactive protein after acute coronary syndrome

Abstract

Inflammation plays an important role in the initiation and progression of atherosclerosis and in the pathogenesis of acute cardiovascular (CV) events. Recent studies focused on the measurement of high sensitivity C-reactive protein (hsCRP) as predictors of CV events. hsCRP has been reported to have prognostic value immediately after ACS and to be associated with CV risk in patients with stable and unstable angina pectoris. To evaluate the association of hsCRP levels with recurrent cardiovascular events in a large prospective study of stable post-ACS patients. Patients with an ACS were enrolled in our department between 2002 and 2007. HsCRP was measured at three month after the ACS together with a global evaluation of atherosclerosis burden and risk factors. Optimal medical treatment, a therapeutic and dietary education program was started during the acute phase and adjusted at 3 months. 1202 patients with hsCRP < 15 mg/l were included and the first 795 patients were followed for an average of 22 months. 94% and 75% of the patients received a combination of b–blocker, anti- aggregates and cholesterol-lowering drugs respectively at 3 and 22 months. LDL-cholesterol, HbA1c, waist circumference, systolic blood pressure, metabolic syndrome, tobacco consumption, and atherosclerosis burden were higher in the 2nd and 3th tertile of hsCRP (p<0.001), at 3 months. hsCRP was associated with recurrence of total CV events (12,0%) (HR 1.34, CI 1.02-1.75) but was not an independent predictor of events after adjustment to traditional CV risk factors (HR 1.19, CI 0.91-1.56). hsCRP did not significantly improve the c-statistics of the Framingham risk evaluation. Hs CRP is associated with cardiovascular risk factors, but is not an independent predictor of totals events in post-ACS patients receiving optimized secondary prevention.