Impact of C-reactive Protein and Fibrinogen on Cardiovascular Prognosis in Patients with Stable Angina Pectoris: the AtheroGene Study

Aims: C-reactive protein and fibrinogen have been extensively studied and shown to be predictive for a first cardiovascular event in healthy individuals. We evaluated the potential clinical use of C-reactive protein and fibrinogen in patients already suffering from coronary artery disease (CAD).

Methods And Results: In a substudy of the prospective AtheroGene registry, we assessed in 1806 patients with documented CAD and stable angina pectoris, the risk of cardiovascular death and non-fatal myocardial infarction (n=183) over a median follow-up of 3.5 (maximum 7.7) years according to baseline levels of C-reactive protein and fibrinogen. C-reactive protein and fibrinogen were associated with future cardiovascular events, such as an increment in one standard deviation of C-reactive protein is associated with a 1.15-fold (95% CI 1.05-1.27, P=0.002) increase, an increment of one standard deviation of fibrinogen with a 1.27-fold (95% CI 1.12-1.43, P<0.0005) increase in hazard risk in the models adjusted for age and sex. Adjustment for traditional risk factors and clinical confounders did not significantly attenuate this relationship. In a comparison of a basic model (traditional risk factors; AUC=0.68) with models additionally including either C-reactive protein (AUC=0.69) or fibrinogen (AUC=0.70), only little additional predictive information over that obtained from assessment of traditional risk factors was obtained.

Conclusion: In patients with documented CAD, C-reactive protein and fibrinogen were predictive for future cardiovascular risk, but did not provide further information on top of that obtained from models including traditional risk factors. Our data emphasize the clinical importance of traditional risk factors in patients with CAD.