The prevalence of elevated levels of high-sensitivity C-reactive protein (hsCRP) was found to progressively increase in patients who undergo percutaneous coronary intervention (PCI) with increasing body mass index (BMI), according to a study published in JACC: Cardiovascular Interventions.
Investigators analyzed data from 14,140 patients (mean age, 65.67 ± 11.00 years; 29.3% women; 48.2% white; mean BMI, 28.82 ± 5.26) who underwent PCI between January 2009 and June 2017 at a large tertiary care center. The participants were grouped into 4 BMI categories: normal (BMI: 18.5 to <25 kg/m2; n=2808), overweight (BMI: 25 to <30 kg/m2; n=6015), obese (BMI: 30 to <35 kg/m2; n=3490), and severely obese (BMI: ≥35 kg/m2; n=1827). Elevated hsCRP was defined as >3 mg/L. The study’s primary end point was occurrence of major adverse cardiac events (MACE; ie, death, myocardial infarction, or target vessel revascularization) within 1 year of PCI.
Elevated hsCRP levels were observed in 18.9%, 23.6%, 33.3%, and 47.7% of the normal, overweight, obese, and severely obese groups, respectively. MACE rates were consistently higher in patients with elevated vs normal hsCRP levels in all BMI categories (normal, 13.4% vs 8.3%, respectively; overweight, 11.2% vs 7.2%, respectively; obese, 10.6% vs 7.5%, respectively; and severely obese, 11.9% vs 6.5%, respectively; P <.01 for all).
After multivariate adjustment, hsCRP elevation remained significantly associated with MACE independent of BMI (hazard ratios: normal, 1.43; 95% CI, 1.04-1.95; overweight, 1.56; 95% CI, 1.21-1.88; obese, 1.40; 95% CI, 1.06-1.84; and severely obese, 1.92; 95% CI, 1.35 to 2.75; P <.05 for all).
“The prevalence of hsCRP elevation progressively increased from normal to overweight, obese, and severely obese patients,” noted the researchers. “Elevated hsCRP was associated with an increased risk for unfavorable outcomes after PCI across all BMI categories.”
The risk for mortality associated with hsCRP elevation increased with higher BMI, and elevated hsCRP was associated with unfavorable outcomes regardless of BMI in male patients but not in female patients.
“Measurement of hsCRP added important prognostic information despite excessive adiposity and may thus help identify subjects at risk across a broad range of BMI,” noted the study authors.
Study limitations include its retrospective design, and the fact that the cohort consisted of patients with a high cardiovascular risk from a metropolitan area in the United States and may not be representative of the general population.
“Our results have important clinical implications, as they affirm both the robust link between inflammatory state and adverse outcome after PCI across a broad range of BMI as well as the role of hsCRP in identifying subjects at risk,” the investigators concluded.
Disclosures: Some of the study authors reported affiliations with pharmaceutical companies. Please see the original reference for a full list of disclosures.
Beyhoff N, Cao D, Mehran R, et al. Prognostic impact of high-sensitivity C-reactive protein in patients undergoing percutaneous coronary intervention according to BMI. J Am Coll Cardiol Intv. 2020;13(24):2882-2892.