C-Reactive Protein and Risk of Incident Heart Failure in Patients With Cardiovascular Disease

Pascal M Burger 1, Stefan Koudstaal 2, Arend Mosterd 3, Aernoud T L Fiolet 4, Martin Teraa 5, Manon G van der Meer 4, Maarten J Cramer 4, Frank L J Visseren 1, Paul M Ridker 6, Jannick A N Dorresteijn 7; UCC-SMART study group

Published: 1 August 2023

Background: Patients with established cardiovascular disease (CVD) are at high risk of incident heart failure (HF), which may in part reflect the impact of systemic inflammation.

Objectives: The goal of this study was to determine the association between C-reactive protein (CRP) and incident HF in patients with established CVD.

Methods: Patients from the prospective UCC-SMART (Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease) cohort with established CVD, but without prevalent HF were included (n = 8,089). Incident HF was defined as a first hospitalization for HF. The association between baseline CRP and incident HF was assessed using Cox proportional hazards models adjusted for established risk factors (ie, age, sex, myocardial infarction, smoking, diabetes mellitus, body mass index, blood pressure, cholesterol, and kidney function).

Results: During a median follow-up of 9.7 years (IQR 5.4-14.1 years), 810 incident HF cases were observed (incidence rate 1.01/100 person-years). Higher CRP was independently associated with an increased risk of incident HF: HR per 1 mg/L: 1.10 (95% CI: 1.07-1.13), and for last vs first CRP quartile: 2.22 (95% CI: 1.76-2.79). The association was significant for both HF with reduced (HR: 1.09; 95% CI: 1.04-1.14) and preserved ejection fraction (HR: 1.12; 95% CI: 1.07-1.18) (P for difference = 0.137). Additional adjustment for medication use and interim myocardial infarction did not attenuate the association, and the association remained consistent beyond 15 years after the CRP measurement.

Conclusions: In patients with established CVD, CRP is an independent risk marker of incident HF. These data support ongoing trial efforts to assess whether anti-inflammatory agents can reduce the burden of HF.

Keywords: C-reactive protein; atherosclerotic vascular disease; heart failure; inflammation; secondary prevention.

Full Access Link: Journal of the American College of Cardiology