Introduction: Inflammation drives atherosclerosis and its complications. Thus, CANTOS as the first anti-inflammatory outcome trial in this population produced positive results. However, it is unclear how many patients qualify for an anti-inflammatory therapy in everyday practice.
Hypothesis: This study analyzes how many patients with coronary heart disease (CHD) on guideline conform therapy show an increased residual inflammatory as opposed to an increased residual lipid risk in order to define the need for an anti-inflammatory treatment in a real world setting.
Methods: High sensitive C-reactive protein (hsCRP) and low density lipoprotein (LDL) levels were determined in 700 all comer patients between June 2016 and June 2017 in our center. Patients lacking CHD, such with chronic-inflammatory diseases, acute inflammation, and on immunosuppressive medication were excluded. Patients were divided in the following groups: elevated hsCRP (≥2mg/dl), normal hsCRP (<2mg/dl), off target LDL-cholesterol (≥70mg/dl), on target LDL-cholesterol (<70mg/dl). Univariate logistic regression and backward selection was performed in order to define factors influencing hsCRP.
Results: From 700 patients 221 fulfilled the inclusion and exclusion criteria. HsCRP was increased in 45% of these patients. Patients with on target LDL Levels showed lower hsCRP concentrations than those with off target values of LDL confirming a positive association between both (1,92mg/dl vs. 3,15mg/dl, p=0.005). However, despite guideline-conform LDL-control 34% of patients with a LDL-cholesterol <70mg/dl had elevated levels of hsCRP (≥2mg/dl) suggestive of residual inflammation. After logistic univariate regression LDL-cholesterol ≥70mg/dl (OR 2.15, p=0.014), heart failure (OR 3.07, p<0.001) and diabetes mellitus (OR 2.22, p=0.021) independently predicted elevated levels of hsCRP. Heart failure (OR 4.56, p<0.001) and diabetes together (OR 3.04, p=0.012) identified as co-predictors increased hsCRP following backward selection.
Conclusions: A substantial part of patients with CHD shares a residual inflammatory risk defining a need for an anti-inflammatory therapy. Residual inflammation is particularly prevalent in patients with heart failure and diabetes.