Abstract 5624: C-Reactive Protein Predicts First Coronary Events but Not Recurrent Stroke: Results From the SPARCL Study

Abstract

Background: The inflammatory biomarker C-reactive protein (CRP) predicts the risk for cardiovascular events. The placebo-controlled Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial evaluated the effect of atorvastatin 80 mg/d on the risk of stroke and major coronary events (COR) in patients with a recent stroke or transient ischemic attack and no known coronary heart disease (CHD). This nested case-control analysis of SPARCL data investigated whether CRP levels at enrolment (1– 6 months after stroke) predicted recurrent stroke or first major coronary events (COR: cardiac death or MI) in placebo-treated patients in this unique patient population. Methods: Baseline CRP was measured in 1,243 of 2,366 placebo-treated SPARCL patients, including 278 who had a recurrent stroke, and 94 who had a COR. Baseline characteristics of the sub-study and total SPARCL populations were similar. The predictive value of AHA/CDC recommended cut-points for CRP (<1 [reference group], 1–3, >3 mg/L) was evaluated without and with adjustments for age, gender, smoking, diabetes, entry event, time since entry event, geographic region and race. Results: Baseline CRP (median [interquartile range]) was 2.08 [0.96, 4.66] mg/L. Higher baseline CRP predicted COR but not recurrent stroke (Table ). The results were similar using quartiles of CRP. Conclusion : In this unique cohort of subjects with cerebrovascular disease but no known CHD, baseline CRP predicted COR, but not recurrent stroke. These results point to potentially important differences in the role of inflammation for first coronary vs. recurrent cerebrovascular events.