Inflammation and future risk of symptomatic heart failure in patients with stable coronary artery disease

Am Heart J. 2014 May;167(5):707-14. doi: 10.1016/j.ahj.2014.01.008. Epub 2014 Feb 22.


Background: Heart failure (HF) carries poor prognosis in coronary artery disease (CAD) patients despite advances in therapy. Inflammation predicts recurrent cardiovascular events in CAD patients. It is unknown whether increased levels of inflammatory markers are associated with incident HF in these patients.

Aim: The aims of this study were to evaluate the association between inflammatory markers and future HF risk in patients with stable CAD and to explore possible mediation by myocardial infarction (MI).

Methods: The study comprised 2,945 patients with stable CAD without HF at baseline during a median follow-up of 7.9 years. Inflammatory baseline markers were the basis of this study.

Results: Heart failure was diagnosed in 508 patients (17.2%). Patients who developed HF were older and had more often previous MI, diabetes, hypertension, and peripheral vascular disease. Baseline levels of C-reactive protein (CRP), fibrinogen, and white blood cells (WBCs) were significantly higher in patients who developed HF compared with those who did not. Age-adjusted incident HF rates were related to elevated baseline inflammatory markers in a dose-response manner. Adjusting for multiple confounders, the HF hazard ratios were 1.38 (95% CI 1.11-1.72), 1.33 (95% CI 1.07-1.66), and 1.36 (95% CI 1.10-1.68) for the third tertiles of CRP, fibrinogen, and WBC levels, respectively. Hazard ratio for the fifth quintile of a combined "inflammation score" was 1.83 (95% CI 1.40-2.39). Mediation by MI preceding the HF onset during follow-up accounted for 10.4%, 10.8%, and 8.6% of the association of subsequent HF with CRP, fibrinogen, and WBC, respectively.

Conclusions: Increased levels of CRP, fibrinogen, and WBC are independently related to the incidence of HF in patients with stable CAD.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Age Factors
  • Aged
  • Bezafibrate / administration & dosage
  • Biomarkers / blood*
  • C-Reactive Protein / metabolism
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / drug therapy
  • Female
  • Fibrinogen / metabolism
  • Follow-Up Studies
  • Heart Failure / blood*
  • Heart Failure / complications
  • Heart Failure / epidemiology
  • Humans
  • Hypolipidemic Agents / administration & dosage
  • Incidence
  • Inflammation / blood*
  • Israel / epidemiology
  • Leukocyte Count
  • Male
  • Middle Aged
  • Risk Factors
  • Time Factors


  • Biomarkers
  • Hypolipidemic Agents
  • Fibrinogen
  • C-Reactive Protein
  • Bezafibrate