Usefulness of high-sensitivity CRP increases during circadian rhythm for prediction of long-term cardiovascular events in patients with stable coronary artery disease [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2011; 39(7): 568-575 | DOI: 10.5543/tkda.2011.01649

Usefulness of high-sensitivity CRP increases during circadian rhythm for prediction of long-term cardiovascular events in patients with stable coronary artery disease

Mevlüt Koç1, Durmuş Yıldıray Şahin1, Onur Kadir Uysal1, Osman Karaarslan1, Esra İşler1, Gülcan Abalı2, Mustafa Kemal Batur2
1Department of Cardiology, Adana Numune Education And Research Hospital, Adana, Turkey
2Department of Cardiology, Acıbadem University Adana Acıbadem Hospital, Adana, Turkey


OBJECTIVES
We investigated the value of circadian variations in high sensitivity C-reactive protein (hs-CRP) levels in prediction of long-term cardiovascular events (CVE) in patients with stable coronary artery disease (CAD).

STUDY DESIGN
The study included 94 patients (70 men, 24 women; mean age 58±9 years) with stable CAD. High sensitivity CRP levels were measured at six-hour intervals, namely, morning (06: 00), midday (12: 00), evening (18: 00), and midnight (24: 00). Absolute change in hs-CRP (absolute ΔCRP) was calculated by subtracting the midday hs-CRP level from that of the morning. Relative change in hs-CRP (relative ΔCRP) was calculated by dividing absolute ΔCRP by the midday hs-CRP level. The patients were followed-up for a mean of 40.2±8.0 months for monitoring of CVE.

RESULTS
During the follow-up period, CVE occurred in 24 patients (25.5%). Patients who developed CVE exhibited significantly higher serum creatinine, B-type natriuretic peptide, morning, evening, and midnight hs-CRP levels, absolute and relative ΔCRP, and left atrial end-diastolic diameter compared to patients without CVE (p<0.05). In logistic regression analysis, only left atrial end-diastolic diameter and absolute ΔCRP were independent predictors of CVE (OR=1.11, 95% CI 1.003-1.236, p=0.044 and OR=1.58, 95% CI 1.195-2.090, p=0.001, respectively). Every 1 mg/l increase in absolute ΔCRP represented a 58.1% increase in CVE risk. In receiver operating characteristics curve analysis, the cut-off value of 2 mg/l for absolute ΔCRP predicted CVE with 89.5% sensitivity and 84.2% specificity.

CONCLUSION
Our findings suggest that absolute circadian increases in hs-CRP levels may be helpful in predicting long-term CVEs in patients with stable CAD.

Keywords: Biological markers, C-reactive protein, circadian rhythm, coronary artery disease; prognosis

How to cite this article
Mevlüt Koç, Durmuş Yıldıray Şahin, Onur Kadir Uysal, Osman Karaarslan, Esra İşler, Gülcan Abalı, Mustafa Kemal Batur. Usefulness of high-sensitivity CRP increases during circadian rhythm for prediction of long-term cardiovascular events in patients with stable coronary artery disease. Turk Kardiyol Dern Ars. 2011; 39(7): 568-575

Corresponding Author: Mevlüt Koç, Türkiye
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