P2670Need of Treating Residual Inflammatory Activity in Coronary Heart Disease: the value of high sensitive CRP and LDL in a Real World Cohort

Abstract

Objectives: 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. Patients lacking CHD, such with chronic-inflammatory diseases, acute inflammation, and on immunosuppressive medication were excluded. Patients were divided in following groups: elevated hsCRP (2mg/dl), normal hsCRP (<2mg/dl), off target LDL-cholesterol (70 mg/dl), on target LDL-cholesterol (<70 mg/dl). Results: From 700 patients 221 fulfilled the inclusion 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 (1,92 mg/dl vs. 3,15 mg/dl, p=0,0054). However, despite guideline-conform LDL-control 34% of patients with LDL-cholesterol <70mg/dl had elevated levels of hsCRP 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. Conclusion: Our data suggest that 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.