Blood marker can signal trouble for individuals with heart disease

November 07, 1999

DALLAS, Nov. 9 -- Individuals with unstable angina who have higher levels of a protein associated with inflammation are more likely to have a heart attack than individuals with lower levels, according to a study in today's Circulation: Journal of the American Heart Association.

The substance called C-reactive protein -- CRP -- circulates in the blood. Levels of the protein rise when the body is fending off an infection. Previous studies indicate that men with high levels of CRP have triple the risk of heart attack and double the risk of stroke compared to men with lower CRP levels. In women, studies have shown that elevated levels of CRP may increase the risk of a heart attack by as much as seven times.

Oscar O. Bazzino, M.D., chief of cardiology at the Italian Hospital of Buenos Aires in Argentina and lead author of the study, says the research is the first to demonstrate the independent value of CRP in individuals who are medically stabilized after an episode of severe chest pain caused by blockages in a blood vessel of the heart. Individuals with the condition, called unstable angina, are at high risk for developing a heart attack or stroke.

The study included 105 unstable angina patients admitted to the Italian Hospital.

Individuals with unstable angina and high levels of CRP -- greater than 1.5 milligrams per deciliter -- had nearly double the risk of heart attacks within 90 days of hospital discharge compared to patients with lower CRP levels. The findings provide new insight into CRP, a substance that in recent years has been recognized as a possible risk factor for heart disease and stroke. Researchers have suggested that the blockages in blood vessels, called plaque, are collections of cellular components, including CRP. Thus the amount of CRP in the blood may be a sign of severe atherosclerosis, the disease process that leads to heart attacks and strokes.

The patients in the study were hospitalized for an average of eight days. Their CRP levels were measured at the time of admission, 48 hours later, and again just before they left the hospital.

Individuals with the highest CRP levels at the time they were released from the hospital were more likely to have chest pain that did not respond to drugs and other treatment. They were also more likely to have a heart attack than patients with the lower CRP levels, and more likely to die of any cause within three months of hospital discharge.

The variations in CRP levels between the two groups of patients at the time they left the hospital cannot be explained by any differences in the way the patients were treated during hospitalization, Bazzino says. Both groups of patients received similar medications to increase blood flow to the heart and prevent blood clots.

"If the findings of this study are confirmed in larger trials, individuals with elevated CRP levels could be selected for more aggressive treatment. These treatments might include prolonged heparin therapy to prevent blood clots as well as coronary artery bypass surgery and balloon angioplasty to unblock blood vessels," Bazzino says.

"An important finding of our study was that CRP may offer physicians an additional tool for predicting which patients with unstable angina will suffer heart attacks within 90 days after hospital discharge. It provides information that goes beyond clinical data and standard non-invasive tests."

Co-authors are Ernesto R. Ferreiros, M.D.; Carlos P. Boissonnet, M.D.; Rodolfo Pizarro, M.D.; Pablo F. Garcia Merletti, M.D.; Gianni Corrado, M.D.; and Arturo Cagide, M.D.
Media advisory: Dr. Bazzino can be reached at 54-11-4958-2800 Ext. 8771, by fax at 54-11-4958-2623 and by E-mail at (Please do not publish numbers.)

American Heart Association

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