High levels of C-reactive protein with low total cholesterol concentrations additively predict all-cause mortality in patients with coronary artery disease

L. Jánoskuti, Z. Förhécz, N. Hosszúfalusi, M. Kleiber, S. Walentin, O. Bálint, J. Duba, S. Rugonfalvi-Kiss, L. Romics, I. Karádi, G. Füst, Z. Prohászka

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Abstract

Background: This study aimed to investigate independent and additive predictive effects of raised C-reactive protein (CRP) levels and decreased total cholesterol levels on mortality in patients with chronic coronary artery disease (CAD). Low total cholesterol (TC) levels are associated with worsened survival in chronic and acute diseases. Elevated CRP level is an important predictor of vascular events and mortality in patients with CAD. Potential inhibition of immune activation by circulating lipoproteins could be a link between cholesterol and inflammatory markers. Materials and methods: A group of 387 patients (median age 59 years) with CAD and with or without severe heart failure (HF) were followed for a median of 5.06 years. Serum total cholesterol and CRP concentrations were measured at enrollment. Results: The relationship between lipoproteins, CRP and survival was explored. High CRP concentrations were in significant association with severity of HF and predicted worsened survival in patients with CAD (hazard ratio 5.214, 95% CI 1.762-15.427). The association between CRP levels and mortality was independent of potential confounding factors such as age, body-mass index, severity of HF, smoking habits, hypertension and TC levels. The prediction of mortality by lowTC levels was significant (hazard ratio 2.932, 95% CI 1.021-8.422). Furthermore, patients with increased CRP and decreased TC (additive predictive effect) phenotypehad 11.714-times higher risk (95% CI 2.619-52.385) of being nonsurvivors than patients with low CRP/highTC. Conclusions: High CRP levels and low TC concentrations are independent and additive predictors of mortality in patients with CAD. Our data indicate that joint analysis of circulating lipoproteins and inflammatory biomarkers may improve prediction of survival in patients with CAD.

Original languageEnglish
Pages (from-to)104-111
Number of pages8
JournalEuropean Journal of Clinical Investigation
Volume35
Issue number2
DOIs
Publication statusPublished - febr. 2005

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C-Reactive Protein
Coronary Artery Disease
Cholesterol
Mortality
Lipoproteins
Survival
Heart Failure
Hazards
Association reactions
Biomarkers
Acute Disease
Habits
Blood Vessels
Body Mass Index
Chronic Disease
Smoking
Chemical activation
Hypertension
Serum

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{9a5b45126ad24d5298ac4caff8032655,
title = "High levels of C-reactive protein with low total cholesterol concentrations additively predict all-cause mortality in patients with coronary artery disease",
abstract = "Background: This study aimed to investigate independent and additive predictive effects of raised C-reactive protein (CRP) levels and decreased total cholesterol levels on mortality in patients with chronic coronary artery disease (CAD). Low total cholesterol (TC) levels are associated with worsened survival in chronic and acute diseases. Elevated CRP level is an important predictor of vascular events and mortality in patients with CAD. Potential inhibition of immune activation by circulating lipoproteins could be a link between cholesterol and inflammatory markers. Materials and methods: A group of 387 patients (median age 59 years) with CAD and with or without severe heart failure (HF) were followed for a median of 5.06 years. Serum total cholesterol and CRP concentrations were measured at enrollment. Results: The relationship between lipoproteins, CRP and survival was explored. High CRP concentrations were in significant association with severity of HF and predicted worsened survival in patients with CAD (hazard ratio 5.214, 95{\%} CI 1.762-15.427). The association between CRP levels and mortality was independent of potential confounding factors such as age, body-mass index, severity of HF, smoking habits, hypertension and TC levels. The prediction of mortality by lowTC levels was significant (hazard ratio 2.932, 95{\%} CI 1.021-8.422). Furthermore, patients with increased CRP and decreased TC (additive predictive effect) phenotypehad 11.714-times higher risk (95{\%} CI 2.619-52.385) of being nonsurvivors than patients with low CRP/highTC. Conclusions: High CRP levels and low TC concentrations are independent and additive predictors of mortality in patients with CAD. Our data indicate that joint analysis of circulating lipoproteins and inflammatory biomarkers may improve prediction of survival in patients with CAD.",
keywords = "C-reactive protein, Coronary artery disease, Mortality, Total cholesterol",
author = "L. J{\'a}noskuti and Z. F{\"o}rh{\'e}cz and N. Hossz{\'u}falusi and M. Kleiber and S. Walentin and O. B{\'a}lint and J. Duba and S. Rugonfalvi-Kiss and L. Romics and I. Kar{\'a}di and G. F{\"u}st and Z. Proh{\'a}szka",
year = "2005",
month = "2",
doi = "10.1111/j.1365-2362.2005.01465.x",
language = "English",
volume = "35",
pages = "104--111",
journal = "European Journal of Clinical Investigation",
issn = "0014-2972",
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number = "2",

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TY - JOUR

T1 - High levels of C-reactive protein with low total cholesterol concentrations additively predict all-cause mortality in patients with coronary artery disease

AU - Jánoskuti, L.

AU - Förhécz, Z.

AU - Hosszúfalusi, N.

AU - Kleiber, M.

AU - Walentin, S.

AU - Bálint, O.

AU - Duba, J.

AU - Rugonfalvi-Kiss, S.

AU - Romics, L.

AU - Karádi, I.

AU - Füst, G.

AU - Prohászka, Z.

PY - 2005/2

Y1 - 2005/2

N2 - Background: This study aimed to investigate independent and additive predictive effects of raised C-reactive protein (CRP) levels and decreased total cholesterol levels on mortality in patients with chronic coronary artery disease (CAD). Low total cholesterol (TC) levels are associated with worsened survival in chronic and acute diseases. Elevated CRP level is an important predictor of vascular events and mortality in patients with CAD. Potential inhibition of immune activation by circulating lipoproteins could be a link between cholesterol and inflammatory markers. Materials and methods: A group of 387 patients (median age 59 years) with CAD and with or without severe heart failure (HF) were followed for a median of 5.06 years. Serum total cholesterol and CRP concentrations were measured at enrollment. Results: The relationship between lipoproteins, CRP and survival was explored. High CRP concentrations were in significant association with severity of HF and predicted worsened survival in patients with CAD (hazard ratio 5.214, 95% CI 1.762-15.427). The association between CRP levels and mortality was independent of potential confounding factors such as age, body-mass index, severity of HF, smoking habits, hypertension and TC levels. The prediction of mortality by lowTC levels was significant (hazard ratio 2.932, 95% CI 1.021-8.422). Furthermore, patients with increased CRP and decreased TC (additive predictive effect) phenotypehad 11.714-times higher risk (95% CI 2.619-52.385) of being nonsurvivors than patients with low CRP/highTC. Conclusions: High CRP levels and low TC concentrations are independent and additive predictors of mortality in patients with CAD. Our data indicate that joint analysis of circulating lipoproteins and inflammatory biomarkers may improve prediction of survival in patients with CAD.

AB - Background: This study aimed to investigate independent and additive predictive effects of raised C-reactive protein (CRP) levels and decreased total cholesterol levels on mortality in patients with chronic coronary artery disease (CAD). Low total cholesterol (TC) levels are associated with worsened survival in chronic and acute diseases. Elevated CRP level is an important predictor of vascular events and mortality in patients with CAD. Potential inhibition of immune activation by circulating lipoproteins could be a link between cholesterol and inflammatory markers. Materials and methods: A group of 387 patients (median age 59 years) with CAD and with or without severe heart failure (HF) were followed for a median of 5.06 years. Serum total cholesterol and CRP concentrations were measured at enrollment. Results: The relationship between lipoproteins, CRP and survival was explored. High CRP concentrations were in significant association with severity of HF and predicted worsened survival in patients with CAD (hazard ratio 5.214, 95% CI 1.762-15.427). The association between CRP levels and mortality was independent of potential confounding factors such as age, body-mass index, severity of HF, smoking habits, hypertension and TC levels. The prediction of mortality by lowTC levels was significant (hazard ratio 2.932, 95% CI 1.021-8.422). Furthermore, patients with increased CRP and decreased TC (additive predictive effect) phenotypehad 11.714-times higher risk (95% CI 2.619-52.385) of being nonsurvivors than patients with low CRP/highTC. Conclusions: High CRP levels and low TC concentrations are independent and additive predictors of mortality in patients with CAD. Our data indicate that joint analysis of circulating lipoproteins and inflammatory biomarkers may improve prediction of survival in patients with CAD.

KW - C-reactive protein

KW - Coronary artery disease

KW - Mortality

KW - Total cholesterol

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DO - 10.1111/j.1365-2362.2005.01465.x

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JO - European Journal of Clinical Investigation

JF - European Journal of Clinical Investigation

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