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Link between hsCRP levels and future cardiac events after ACS examined

By Nicole MacKee
Monitoring high-sensitivity C-reactive protein (hsCRP) levels in the weeks after acute coronary syndrome (ACS) may help clinicians to better identify patients at increased risk of future major adverse cardiac events, say international researchers.

In a secondary analysis of the Vascular Inflammation Suppression to Treat Acute Coronary Syndromes for 16 Weeks (VISTA-16) trial, reported in JAMA Cardiology, researchers analysed baseline and longitudinal hsCRP levels in more than 4000 patients after ACS. Most patients were men (74%), and the mean age was 60 years. 

After multivariable analysis, they found that higher baseline hsCRP level (hazard ratio [HR], 1.36) and higher longitudinal hsCRP level (HR, 1.15) were independently associated with major adverse cardiac events (MACE, a composite of cardiovascular death, myocardial infarction, nonfatal stroke or unstable angina with ischaemia requiring hospitalisation). Similar and independent associations were shown between baseline and longitudinal hsCRP levels and cardiovascular death and between longitudinal hsCRP levels and all-cause death. 

The association was found despite the use of optimal evidence-based medical therapies, the researchers reported.

For the analysis, hsCRP levels were measured at weeks 1, 2, 4, 8 and 16 after randomisation to treatment or placebo.

VISTA-16 Study Chair Professor Stephen Nicholls, Professor of Cardiology at Monash University, Melbourne, said hsCRP was not being used to any substantial degree in Australian cardiology practice, and it did not feature prominently in local guidelines.

He said the findings may help to guide clinicians in how to most effectively triage patients with ACS to more intensive therapy.

‘[These findings] continue to support the concept that inflammation is important,’ Professor Nicholls told Cardiology Today. ‘How that translates in terms of new risk markers in practice or new therapies remains to be determined.'

The VISTA-16 trial was conducted between 2010 and 2012 and included more than 5000 patients from Europe, Australia, New Zealand, India and North America assigned to receive varespladib (not available in Australia) or placebo on a background of atorvastatin treatment beginning within 96 hours of presentation with an ACS.
JAMA Cardiol 2019; doi: 10.1001/jamacardio.2019.0179.