Inflammation and risk of heart failure in coronary artery disease

This paper studied whether markers of inflammation are risk factors for heart failure in patients with coronary artery disease. Authors concluded that inflammation markers were significantly associated with heart failure. 

Coronary artery disease occurs when the blood vessels supplying the heart become hardened and narrowed. This increases the risk of heart failure. Inflammation refers to the body’s response to damage or infection. Inflammation can occur following repeated heart disease-related events in patients with coronary artery disease. Markers for inflammation include CRP (C-reactive protein; elevated in the blood in case of inflammation), fibrinogen (protein produced by the liver to help blood clots form), and white blood cells (cells that help fight infection). It is unknown whether increased levels of inflammatory markers are associated with heart failure in patients with coronary artery disease. 

2,945 patients with stable (controlled) coronary artery disease were analyzed. None of the patients showed heart failure at the beginning of the study. Markers of inflammation such as CRP, fibrinogen, and white blood cells were recorded. The rates of heart failure were examined over an average period of 7.9 years.

17% of patients developed heart failure during the study period. On average, patients who developed heart failure were older, more likely to have had a previous heart attack, and had higher blood pressure.

Patients who went on to develop heart failure had higher average CRP levels, fibrinogen levels, and white blood cell levels at the beginning of the study. 

Patients were compared depending on whether they had upper, middle or lowest third level of inflammation marker. Patients with CRP levels in the upper third of the spectrum had a 38% higher heart failure risk compared to patients with CRP levels in the lower third. Heart failure risk increased by 33% among patients with an upper third level of fibrinogen. When white blood cell levels were in the upper third, the risk of heart failure increased by 36%.  

When all three inflammation markers were analyzed together, patients within the top 20% of inflammation scores had an a 83% increased heart failure risk.

The authors concluded that increased levels of CRP, fibrinogen, and white blood cells are risk factors for heart failure in patients with stable coronary artery disease.