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. 2024 Aug;17(8):e011199.
doi: 10.1161/CIRCHEARTFAILURE.123.011199. Epub 2024 Aug 9.

Trajectory of C-Reactive Protein and Incident Heart Failure in Black Adults: The Jackson Heart Study

Arsalan Hamid  1 , Wondwosen K Yimer  2 , Adebamike A Oshunbade  3 , Muhammad Shahzeb Khan  4 , Daisuke Kamimura  5 , Rodney K Kipchumba  1 , Ambarish Pandey  6 , Donald Clark 3rd  7 , Robert J Mentz  4 , Ervin R Fox  7 , Jarett D Berry  6 , R Brandon Stacey  8 , Amil Shah  9 , Adolfo Correa  1 , Salim S Virani  10   11   12 , Javed Butler  1   13 , Michael E Hall  1   7
Affiliations

Trajectory of C-Reactive Protein and Incident Heart Failure in Black Adults: The Jackson Heart Study

Arsalan Hamid et al. Circ Heart Fail. 2024 Aug.

Abstract

Background: Increased hsCRP (high-sensitivity C-reactive protein), a marker of inflammation, is associated with incident cardiovascular events. We aim to determine whether the baseline or trajectory of hsCRP levels over time predicts incident heart failure (HF) hospitalization.

Methods: JHS (Jackson Heart Study) participants' (n=3920 Black adults) hsCRP levels were measured over 3 visits (from 2000 to 2013). We assessed the association of hsCRP at baseline (visit 1) with incident HF hospitalization using Cox proportional hazards models. Furthermore, we assessed the association of the trajectory of hsCRP over repeated measurements (visits 1-3) with incident HF using joint models. Hazard ratios are reflective of an increase in hsCRP by 1 SD on a log2 scale. We also assessed the association of change in hsCRP between visit 1 and visit 3 with Cox proportional hazards models by grouping patients by low (<2 mg/L) and high (≥2 mg/L) hsCRP levels. The 4 groups were low-to-low (referent), low-to-high, high-to-low, and high-to-high.

Results: Mean baseline age of participants was 54±13 years, and 63.8% were women. Over a median follow-up of 12 years, 308 (7.9%) participants were hospitalized with incident HF. Baseline hsCRP was not associated with incident HF (adjusted hazard ratio, 1.08 [95% CI, 0.96-1.22]). However, increasing hsCRP levels over repeated measures were associated with a higher risk of incident HF overall (adjusted hazard ratio, 1.22 [95% CI, 1.03-1.44]) and HF with preserved ejection fraction (adjusted hazard ratio, 1.30 [95% CI, 1.02-1.65]) but not HF with reduced ejection fraction (P>0.05). Furthermore, changes in hsCRP from low-to-high and high-to-low levels were associated with incident HF (P<0.05).

Conclusions: While baseline hsCRP was not associated with incident HF, an increasing trajectory of hsCRP over time was associated with increased risk for incident HF (particularly HF with preserved ejection fraction). Temporal change in hsCRP may be an important marker of risk for incident HF with preserved ejection fraction in Black adults.

Keywords: biomarkers; heart failure; inflammation; stroke volume.

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Conflict of interest statement

Dr Mentz received research support and honoraria from Abbott, American Regent, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim/Eli Lilly, Boston Scientific, Cytokinetics, Fast BioMedical, Gilead, Innolife, Medtronic, Merck, Novartis, Relypsa, Respicardia, Roche, Sanofi, Vifor, Windtree Therapeutics, and Zoll. Dr Shah reports research support not related to this study from Novartis and Philips Ultrasound and consulting fees from Philips Ultrasound. Dr Virani receives research support from the Department of Veterans Affairs, the National Institutes of Health, and Tahir and Jooma Family. Dr Virani also received an honorarium from the American College of Cardiology in his role as an Associate Editor for Innovations, acc.org. Dr Butler reported personal fees from Abbott, Adrenomed, Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Roche, V-Wave Ltd, and Vifor outside the submitted work. The other authors report no conflicts. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, the US Department of Health and Human Services, or the Department of Veterans Affairs.

Figures

Figure 1.
Figure 1.
hsCRP levels of the participants at A) visit number B) years from baseline.
Figure 2.
Figure 2.
Kaplan Meier survival plots demonstrating association of participants changing in high (≥2 mg/L) and low levels (<2 mg/L) of hsCRP with incident HF hospitalization. HF = heart failure; hsCRP= high sensitivity C-reactive protein.
See this image and copyright information in PMC

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