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High high-sensitivity C-reactive protein/BMI ratio predicts future adverse outcomes in patients with acute coronary syndrome

Jia, Leia; Yuan, Jin-Qinga; Ling, Zhub,*; Zhang, Yina,*

doi: 10.1097/MCA.0000000000000719
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Objective The prognostic value of high-sensitivity C-reactive protein (hsCRP) and obesity in patients with coronary artery disease is controversial. In previous studies, hsCRP was significantly associated with BMI. Thus, we integrated hsCRP and BMI to assess the predictive value in patients with acute coronary syndrome (ACS).

Methods and results In this observational cohort study, 478 patients with ACS were enrolled in Fuwai Hospital from 2010 to 2011,with a mean follow-up of 4.2 years. The endpoint of major adverse cardiovascular events (MACE) was the composite of cardiovascular death, myocardial infarction, revascularization again, heart failure, or stroke. Compared with patients without MACE, we found that patients with MACE had higher hsCRP (3.86±3.66 vs. 3.00±3.17, P=0.033). Furthermore, we identified that hsCRP was significantly correlated with BMI (r=0.134, P=0.005). Thus, hsCRP level was adjusted by BMI to further clarify its role in the prognosis of patients with ACS. According to the tertiles of hsCRP/BMI ratio, the rates of MACE in the lowest tertile group, the median tertile group, and the highest tertile group were 14.0% (21/150), 14.0% (21/150), and 26% (39/150) (P=0.008), respectively. In multivariate analysis, hsCRP/BMI was independently and positively related to MACE. Similarly, according to risk category of hsCRP (low hsCRP group<3.0 mg/l, high hsCRP group≥3.0 mg/l) and BMI (<24 and ≥24.0 kg/m2), patients in the high hsCRP but normal or low weight group had the lowest MACE-free survival (log-rank P=0.003) compared with other groups.

Conclusion We confirmed that C-reactive protein level should be adjusted by BMI to reflect the prognosis of patients with ACS. High hsCRP/BMI ratio was associated with adverse outcomes. Patients with ACS with high hsCRP plus overweight had the same risk for MACE as those with lower hsCRP but normal weight.

aState Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing

bDepartment of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi Province, China

* Zhu Ling and Yin Zhang contributed equally to the writing of this article.

Correspondence to Yin Zhang, MD, State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China Tel: +86 010 883 22455; e-mail: rabbityin2008@qq.com

Received October 22, 2018

Received in revised form January 9, 2019

Accepted January 10, 2019

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