Can C-reactive protein predict cardiovascular events in asymptomatic patients? Analysis based on plaque characterization

Objective: High-sensitivity C-reactive protein (hsCRP) and coronary artery plaque characteristics have been separately evaluated as prognosticators of adverse cardiovascular events; however, their relationship remains unclear. We therefore evaluated the prognostic value of hsCRP in relation to plaque subtypes in predicting adverse cardiovascular outcome in asymptomatic patients without known coronary artery disease.

Methods: A total of 4690 asymptomatic patients who underwent coronary computed tomography angiography for screening purposes were included. HsCRP was categorized as <1 mg/L, 1-3 mg/L and >3 mg/L. Cardiovascular events were defined as cardiovascular death, acute coronary syndrome, and stroke.

Results: During follow-up (median 49 months, interquartile range 34-59 months), adverse cardiovascular events were observed in 56 (1.2%) patients. Higher hsCRP was associated with poor outcome in overall patients (OR 2.716, 95% CI 1.512-4.880, p = 0.001 for hsCRP 1-3 mg/L, OR 2.705, 95% CI 1.239-5.908, p = 0.013 for hsCRP > 3 mg/L, hsCRP <1 mg/L as reference). When patients were evaluated according to plaque subtype, hsCRP > 3 mg/L was a significant predictor of poor outcome only in patients with noncalcified plaques (NCP; p = 0.038). After adjusting for Framingham risk and coronary artery calcium score, hsCRP > 3 mg/L was a significant predictor of adverse outcomes in the presence of NCP (p = 0.048) but not in the presence of CP or MCP (p = 0.742).

Conclusion: Elevated hsCRP is a predictor of adverse cardiovascular events in asymptomatic patients with NCP. After adjusting for Framingham risk and coronary artery calcium scores, hsCRP > 3 mgL remained an independent predictor of risk in patients with NCP but not in patients with CP or MCP.