BACKGROUND: Biomarkers may be helpful in improving risk stratification in cardiovascular diseases. Therefore, we assessed the prognostic value of sensitive inflammatory markers alone and in combination with lipids in patients with stable coronary artery disease (CAD). METHODS: In a prospective cohort study, we recruited 312 patients, aged 40-68 years, with angiographically proven, clinically stable CAD at the University Hospital in Ulm, Germany. C-reactive protein (CRP), interleukin-6 (IL-6), and lipoproteins were measured at baseline in all patients. After a median follow-up of 3.2 years, a fatal or non-fatal cardiovascular event (CVE) had occurred in 60 of 300 patients (20%). RESULTS: Baseline concentrations of IL-6 were significantly higher (3.27 versus 2.45 pg/ml, p=0.02) in patients with a future CVE compared to those without. After multivariate adjustment, patients with elevated baseline concentrations (4th versus 1st quartile) of inflammatory markers showed a moderately increased risk of CVE, i.e., hazard ratios (HR) were 1.3 (95% confidence interval 0.6-2.8) for CRP and 1.8 (0.9-3.6) for IL-6. The HRs increased if both inflammatory and lipid markers were simultaneously elevated (both markers>median versus<median). HR was 1.8 (0.8-4.0) for simultaneously elevated baseline concentrations of CRP and total cholesterol, and 1.9 (0.8-4.7) for simultaneously elevated concentrations of CRP and LDL cholesterol. Corresponding HRs for IL-6 and lipoproteins were 2.0 (0.9-2.7) and 2.1 (0.9-5.0). CONCLUSION: Simultaneous assessment of markers of inflammation and lipid metabolism may improve cardiovascular risk stratification in patients with stable CAD.
BACKGROUND: Biomarkers may be helpful in improving risk stratification in cardiovascular diseases. Therefore, we assessed the prognostic value of sensitive inflammatory markers alone and in combination with lipids in patients with stable coronary artery disease (CAD). METHODS: In a prospective cohort study, we recruited 312 patients, aged 40-68 years, with angiographically proven, clinically stable CAD at the University Hospital in Ulm, Germany. C-reactive protein (CRP), interleukin-6 (IL-6), and lipoproteins were measured at baseline in all patients. After a median follow-up of 3.2 years, a fatal or non-fatal cardiovascular event (CVE) had occurred in 60 of 300 patients (20%). RESULTS: Baseline concentrations of IL-6 were significantly higher (3.27 versus 2.45 pg/ml, p=0.02) in patients with a future CVE compared to those without. After multivariate adjustment, patients with elevated baseline concentrations (4th versus 1st quartile) of inflammatory markers showed a moderately increased risk of CVE, i.e., hazard ratios (HR) were 1.3 (95% confidence interval 0.6-2.8) for CRP and 1.8 (0.9-3.6) for IL-6. The HRs increased if both inflammatory and lipid markers were simultaneously elevated (both markers>median versus<median). HR was 1.8 (0.8-4.0) for simultaneously elevated baseline concentrations of CRP and total cholesterol, and 1.9 (0.8-4.7) for simultaneously elevated concentrations of CRP and LDL cholesterol. Corresponding HRs for IL-6 and lipoproteins were 2.0 (0.9-2.7) and 2.1 (0.9-5.0). CONCLUSION: Simultaneous assessment of markers of inflammation and lipid metabolism may improve cardiovascular risk stratification in patients with stable CAD.