Prognostic value, clinical effectiveness and cost-effectiveness of high sensitivity C-reactive protein as a marker in primary prevention of major cardiac events

Non-fasting changes of Hs-CRP level in Chinese patients with coronary heart disease after a daily meal

High-sensitivity C-reactive protein (hs-CRP) is a key inflammatory factor in atherosclerotic cardiovascular diseases. In Chinese patients with coronary heart disease (CHD), the changes in hs-CRP levels after a daily meal and the effect of statins on those were never explored. A total of 300 inpatients with CHD were included in this study. Hs-CRP levels were measured in the fasting and non-fasting states at 2 h and 4 h after a daily breakfast. All inpatients were divided into two groups according to fasting hs-CRP ≤ 3 mg/L or not. Group with fasting hs-CRP ≤ 3 mg/L had a significantly higher percentage of patients with statins using ≥ 1 month (m) before admission than that with fasting hs-CRP > 3 mg/L (51.4% vs. 23.9%, P < 0.05). Hs-CRP levels increased significantly in the non-fasting state in two groups (P < 0.05). About 32% of patients with non-fasting hs-CRP > 3 mg/L came from those with fasting hs-CRP ≤ 3 mg/L. In conclusion, hs-CRP levels increased significantly in CHD patients after a daily meal. It suggested that the non-fasting hs-CRP level could be a better parameter to evaluate the inflammation state of CHD patients rather than fasting hs-CRP level.

Comparison of Frequency of Atherosclerotic Cardiovascular and Safety Events With Systolic Blood Pressure <120mm Hg Versus 135-139mm Hg in a Systolic Blood Pressure Intervention Trial Primary Prevention Subgroup

Whether the benefit of intensive blood pressure (BP) control reduces atherosclerotic cardiovascular disease (ASCVD) risk without increasing risks of serious adverse events (SAEs) is unknown. We sought to assess differences in incident ASCVD and SAE with intensive BP control across the spectrum of 10-year ASCVD risk in the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT randomized 9,361 participants who were ≥50years old and ≥1 CVD risk factor to standard or intensive BP control (<120 or 130 to 139mm Hg). We excluded adults with clinical ASCVD or age ≥80. We included 6,875 participants. We compared hazard ratios (HR) and risk differences (RD) of incident ASCVD events or SAEs in all and across quartiles of baseline risk. Median predicted ASCVD risk was 15.9%. Intensive BP control significantly reduced ASCVD events (HR 0.75, 95% confidence interval 0.58, 0.97, p = 0.03; RD -0.94; -1.8, -0.1; p = 0.03). There was no difference in effect across quartiles of ASCVD risk. There was a non-significant increase in SAE with intensive BP control (HR 1.08, 1.00, 1.17 p = 0.06; RD 2.1, -0.1, 4.4, p = 0.03), and no difference in this effect across quartiles of risk. In SPRINT participants without baseline clinical ASCVD, the benefit of intensive BP control for primary prevention of ASCVD may extend to lower risk participants without an increase in SAE. In conclusion, lower risk adults with stage 1 hypertension meeting SPRINT eligibility may benefit from initiation of antihypertensives.

Endophenotypes for Age-Related Macular Degeneration: Extending Our Reach into the Preclinical Stages of Disease

The key to reducing the individual and societal burden of age-related macular degeneration (AMD)-related vision loss, is to be able to initiate therapies that slow or halt the progression at a point that will yield the maximum benefit while minimizing personal risk and cost. There is a critical need to find clinical markers that, when combined with the specificity of genetic testing, will identify individuals at the earliest stages of AMD who would benefit from preventive therapies. These clinical markers are endophenotypes for AMD, present in those who are likely to develop AMD, as well as in those who have clinical evidence of AMD. Clinical characteristics associated with AMD may also be possible endophenotypes if they can be detected before or at the earliest stages of the condition, but we and others have shown that this may not always be valid. Several studies have suggested that dynamic changes in rhodopsin regeneration (dark adaptation kinetics and/or critical flicker fusion frequencies) may be more subtle indicators of AMD-associated early retinal dysfunction. One can test for the relevance of these measures using genetic risk profiles based on known genetic risk variants. These functional measures may improve the sensitivity and specificity of predictive models for AMD and may also serve to delineate clinical subtypes of AMD that may differ with respect to prognosis and treatment.