Dr. Michael Fulks discusses recent articles showing that inflammation measured by hsCRP consistently emerges as a key independent predictor of cardiovascular risk across various groups.
This Two recent articles from the European Heart Journal make the risk associated with inflammation clearer. The first by Paul Ridker, et al. is an extension of his prior year’s work using the Women’s Health Study that he reported in the NEJM looking at cardiovascular (CV) events over 30 years based on combinations of risks including inflammation. This time, he looked only at the roughly 45% of women in that cohort who had no hypertension, adverse lipids, DM, or smoking. He compared the rate of major adverse cardiovascular events (MACE) in those with hsCRP <1, 1-3, and >3 mg/L adjusted for age, BMI and eGFR. The relative risk (RR) was 1, 1, and 1.3 for those with hsCRP <1, 1-3, and >3 mg/L. This shows that Inflammation is more than a modifier of risk in those with other identifiable risk factors, but is also a risk predictor, and potential risk mechanism, in those without other adverse findings. These low-risk individuals are representative of applicants allowed entry into highly preferred life insurance underwriting classes.
The second article by Benjamin Bay, et al. looked at those undergoing PTCA and compared the incidence of MACE over the following year split by low vs. high LDL cholesterol (<70 vs ≥70 mg/dL) and low vs. high hsCRP (<2 vs ≥2 mg/L) into cohorts having low-low, high-high, low-high and high-low results. In a Cox multivariate analysis, he found the risk was lowest for those with low-low results (RR=1) but with a surprisingly similar risk in those with high cholesterol but low hsCRP. For those with high hsCRP and high cholesterol or high hsCRP and low cholesterol the RR was elevated at 1.6 and 1.8 respectively. The driver of risk was inflammation measured by hsCRP but not the current LDL level.
These two studies add to the growing body of evidence showing inflammation to be a potent independent risk factor for predicting cardiovascular events (and mortality) in those with and without other CV risk factors. It has value in risk prediction across all older life insurance applicants from best preferred to standard or even substandard classes when based on CV history.
About the Author
Michael Fulks, MD, Consulting Medical Director, is board-certified in internal and insurance medicine. After leaving practice, he served as a medical director, creating or editing several underwriting manuals and preferred programs. More recently, Mike has consulted for CRL participating in its mortality research on laboratory test results, BP and build, and in the development of risk-scoring tools for laboratory and non-laboratory data.