C-reactive protein in heart failure: Prognostic value and the effect of Valsartan

Inder S. Anand, Roberto Latini, Viorel G. Florea, Michael A. Kuskowski, Thomas Rector, Serge Masson, Stefano Signorini, Paolo Mocarelli, Allen Hester, Robert Glazer, Jay N. Cohn

Research output: Contribution to journalArticle

292 Citations (Scopus)

Abstract

Background - The role of C-reactive protein (CRP) in heart failure is not well studied. We assessed the prognostic value of CRP in patients randomized in Val-HeFT (Valsartan Heart Failure Trial) and studied changes in CRP that were associated with valsartan. Methods and Results - Characteristics of patients with baseline CRP levels above and below the median value were compared. Univariable and multivariable Cox proportional hazards regression models were used to examine the relationship of CRP to mortality and morbidity. Interactions were tested to determine whether differences in CRP changes from baseline to 4 and 12 months between groups randomly assigned to valsartan or placebo depended on baseline ACE inhibitor use. Median plasma CRP was 3.23 mg/L (interquartile range 1.42 to 7.56 mg/L), which is higher than in the general population. Patients with CRP above the median had features of more severe heart failure than those with CRP levels below the median. The cumulative likelihood of death and first morbid event increased with increasing quartile of CRP. Relative to the lowest CRP quartile, the risk of mortality (hazard ratio 1.51, 95% CI 1.2 to 1.9) and first morbid event (hazard ratio 1.53, 95% CI 1.28 to 1.84) was increased in the highest CRP quartile in multivariable models. CRP added incremental prognostic information to that provided by brain natriuretic peptide alone. CRP did not change significantly over time in the placebo group; however, after 12 months, valsartan was associated with a decrease in CRP in patients not receiving ACE inhibitors but not in those receiving ACE inhibitors at 12 months. Conclusions - CRP is increased in heart failure. Higher levels are associated with features of more severe heart failure and are independently associated with mortality and morbidity. The ability of treatments to reduce CRP levels and the prognostic importance of reducing CRP require further study.

Original languageEnglish (US)
Pages (from-to)1428-1434
Number of pages7
JournalCirculation
Volume112
Issue number10
DOIs
StatePublished - Sep 6 2005

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Valsartan
C-Reactive Protein
Heart Failure
Angiotensin-Converting Enzyme Inhibitors

Keywords

  • Angiotensin receptor blockers
  • C-reactive protein
  • Heart failure
  • Inflammation
  • Prognosis

Cite this

C-reactive protein in heart failure : Prognostic value and the effect of Valsartan. / Anand, Inder S.; Latini, Roberto; Florea, Viorel G.; Kuskowski, Michael A.; Rector, Thomas; Masson, Serge; Signorini, Stefano; Mocarelli, Paolo; Hester, Allen; Glazer, Robert; Cohn, Jay N.

In: Circulation, Vol. 112, No. 10, 06.09.2005, p. 1428-1434.

Research output: Contribution to journalArticle

Anand, IS, Latini, R, Florea, VG, Kuskowski, MA, Rector, T, Masson, S, Signorini, S, Mocarelli, P, Hester, A, Glazer, R & Cohn, JN 2005, 'C-reactive protein in heart failure: Prognostic value and the effect of Valsartan', Circulation, vol. 112, no. 10, pp. 1428-1434. https://doi.org/10.1161/CIRCULATIONAHA.104.508465
Anand, Inder S. ; Latini, Roberto ; Florea, Viorel G. ; Kuskowski, Michael A. ; Rector, Thomas ; Masson, Serge ; Signorini, Stefano ; Mocarelli, Paolo ; Hester, Allen ; Glazer, Robert ; Cohn, Jay N. / C-reactive protein in heart failure : Prognostic value and the effect of Valsartan. In: Circulation. 2005 ; Vol. 112, No. 10. pp. 1428-1434.
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abstract = "Background - The role of C-reactive protein (CRP) in heart failure is not well studied. We assessed the prognostic value of CRP in patients randomized in Val-HeFT (Valsartan Heart Failure Trial) and studied changes in CRP that were associated with valsartan. Methods and Results - Characteristics of patients with baseline CRP levels above and below the median value were compared. Univariable and multivariable Cox proportional hazards regression models were used to examine the relationship of CRP to mortality and morbidity. Interactions were tested to determine whether differences in CRP changes from baseline to 4 and 12 months between groups randomly assigned to valsartan or placebo depended on baseline ACE inhibitor use. Median plasma CRP was 3.23 mg/L (interquartile range 1.42 to 7.56 mg/L), which is higher than in the general population. Patients with CRP above the median had features of more severe heart failure than those with CRP levels below the median. The cumulative likelihood of death and first morbid event increased with increasing quartile of CRP. Relative to the lowest CRP quartile, the risk of mortality (hazard ratio 1.51, 95{\%} CI 1.2 to 1.9) and first morbid event (hazard ratio 1.53, 95{\%} CI 1.28 to 1.84) was increased in the highest CRP quartile in multivariable models. CRP added incremental prognostic information to that provided by brain natriuretic peptide alone. CRP did not change significantly over time in the placebo group; however, after 12 months, valsartan was associated with a decrease in CRP in patients not receiving ACE inhibitors but not in those receiving ACE inhibitors at 12 months. Conclusions - CRP is increased in heart failure. Higher levels are associated with features of more severe heart failure and are independently associated with mortality and morbidity. The ability of treatments to reduce CRP levels and the prognostic importance of reducing CRP require further study.",
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T2 - Prognostic value and the effect of Valsartan

AU - Anand, Inder S.

AU - Latini, Roberto

AU - Florea, Viorel G.

AU - Kuskowski, Michael A.

AU - Rector, Thomas

AU - Masson, Serge

AU - Signorini, Stefano

AU - Mocarelli, Paolo

AU - Hester, Allen

AU - Glazer, Robert

AU - Cohn, Jay N.

PY - 2005/9/6

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N2 - Background - The role of C-reactive protein (CRP) in heart failure is not well studied. We assessed the prognostic value of CRP in patients randomized in Val-HeFT (Valsartan Heart Failure Trial) and studied changes in CRP that were associated with valsartan. Methods and Results - Characteristics of patients with baseline CRP levels above and below the median value were compared. Univariable and multivariable Cox proportional hazards regression models were used to examine the relationship of CRP to mortality and morbidity. Interactions were tested to determine whether differences in CRP changes from baseline to 4 and 12 months between groups randomly assigned to valsartan or placebo depended on baseline ACE inhibitor use. Median plasma CRP was 3.23 mg/L (interquartile range 1.42 to 7.56 mg/L), which is higher than in the general population. Patients with CRP above the median had features of more severe heart failure than those with CRP levels below the median. The cumulative likelihood of death and first morbid event increased with increasing quartile of CRP. Relative to the lowest CRP quartile, the risk of mortality (hazard ratio 1.51, 95% CI 1.2 to 1.9) and first morbid event (hazard ratio 1.53, 95% CI 1.28 to 1.84) was increased in the highest CRP quartile in multivariable models. CRP added incremental prognostic information to that provided by brain natriuretic peptide alone. CRP did not change significantly over time in the placebo group; however, after 12 months, valsartan was associated with a decrease in CRP in patients not receiving ACE inhibitors but not in those receiving ACE inhibitors at 12 months. Conclusions - CRP is increased in heart failure. Higher levels are associated with features of more severe heart failure and are independently associated with mortality and morbidity. The ability of treatments to reduce CRP levels and the prognostic importance of reducing CRP require further study.

AB - Background - The role of C-reactive protein (CRP) in heart failure is not well studied. We assessed the prognostic value of CRP in patients randomized in Val-HeFT (Valsartan Heart Failure Trial) and studied changes in CRP that were associated with valsartan. Methods and Results - Characteristics of patients with baseline CRP levels above and below the median value were compared. Univariable and multivariable Cox proportional hazards regression models were used to examine the relationship of CRP to mortality and morbidity. Interactions were tested to determine whether differences in CRP changes from baseline to 4 and 12 months between groups randomly assigned to valsartan or placebo depended on baseline ACE inhibitor use. Median plasma CRP was 3.23 mg/L (interquartile range 1.42 to 7.56 mg/L), which is higher than in the general population. Patients with CRP above the median had features of more severe heart failure than those with CRP levels below the median. The cumulative likelihood of death and first morbid event increased with increasing quartile of CRP. Relative to the lowest CRP quartile, the risk of mortality (hazard ratio 1.51, 95% CI 1.2 to 1.9) and first morbid event (hazard ratio 1.53, 95% CI 1.28 to 1.84) was increased in the highest CRP quartile in multivariable models. CRP added incremental prognostic information to that provided by brain natriuretic peptide alone. CRP did not change significantly over time in the placebo group; however, after 12 months, valsartan was associated with a decrease in CRP in patients not receiving ACE inhibitors but not in those receiving ACE inhibitors at 12 months. Conclusions - CRP is increased in heart failure. Higher levels are associated with features of more severe heart failure and are independently associated with mortality and morbidity. The ability of treatments to reduce CRP levels and the prognostic importance of reducing CRP require further study.

KW - Angiotensin receptor blockers

KW - C-reactive protein

KW - Heart failure

KW - Inflammation

KW - Prognosis

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