Received on September 1, 2008
Accepted on November 10, 2008

Lipids, Lipoproteins, and Cardiovascular Risk Factors

Concentrations of C-Reactive Protein and B-type Natriuretic Peptide 30 Days after Acute Coronary Syndromes Independently Predict Hospitalization for Heart Failure and Cardiovascular Death

¹ TIMI Study Group, Cardiovascular Division, Department of Medicine, and Department of Pathology, Brigham and Women's Hospital, Harvard Medical School; Children's Hospital, Harvard Medical School, Boston, MA

^* To whom correspondence should be addressed. E-mail: bscirica{at}partners.org.

BACKGROUND: Heart failure (HF) is an important cause of morbidity in patients with acute coronary syndromes (ACS). C-reactive protein (CRP) has been implicated in experimental models as exacerbating myocardial injury, but data regarding the clinical relationship of high-sensitivity CRP (hsCRP) and B-type natriuretic peptide (BNP) concentrations with the risk of HF after ACS are few.

METHODS: PROVE IT–TIMI 22 randomized 4162 patients who had been stabilized after ACS to either intensive or moderate statin therapy. hsCRP and BNP were measured 30 days after randomization. Hospitalizations for HF and cardiovascular death occurring after day 30 were assessed for a mean follow-up of 24 months.

RESULTS: Patients who developed HF had higher concentrations of hsCRP (3.7 mg/L vs 1.9 mg/L, P < 0.001) and BNP (59 ng/L vs 22 ng/L, P < 0.0001). HF increased in a stepwise manner with hsCRP quartile [adjusted hazard ratio (HR_adj) for Q4 vs Q1, 2.5; P = 0.01] and BNP quartile (HR_adj for Q4 vs Q1, 5.8; P < 0.001), with similar results obtained for cardiovascular death. In a multivariable analysis, higher concentrations of hsCRP and BNP were both independently associated with HF [HR_adj, 1.9 for hsCRP >2.0 mg/L (P = 0.01) and 4.2 for BNP >80 ng/L (P < 0.001)]. Patients with increases in both markers were at the greatest risk of HF, compared with patients without an increased marker concentration (HR_adj, 8.3; P = 0.01). The benefit of intensive statin therapy in reducing HF was consistent among all patients, regardless of hsCRP or BNP concentration.

CONCLUSIONS: Both hsCRP and BNP measured 30 days after ACS are independently associated with the risk of HF and cardiovascular death, with the greatest risk occurring when both markers are increased.