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(Circulation. 2003;107:245.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

C-Reactive Protein and Ischemia in Users and Nonusers of ß-Blockers and Statins

Data From the Heart and Soul Study

Mary S. Beattie, MD; Michael G. Shlipak, MD, MPH; Haiying Liu, MD, MPH; Warren S. Browner, MD, MPH; Nelson B. Schiller, MD; Mary A. Whooley, MD

From the Departments of Medicine (M.S.B., M.G.S., W.S.B., N.B.S., M.A.W.) and Epidemiology and Biostatistics (M.G.S., W.S.B., M.A.W.) and the Division of Cardiology (N.B.S.), University of California, San Francisco; the Section of General Internal Medicine, VA Medical Center (M.G.S., H.L., M.A.W.); and Research Institute, California Pacific Medical Center (W.S.B.), San Francisco.

Correspondence to M.A. Whooley, MD, VA Medical Center (111A1), 4150 Clement St, San Francisco, CA 94121. E-mail whooley{at}itsa.ucsf.edu

Background— Elevated levels of C-reactive protein (CRP) are associated with an increased risk of coronary events, but whether inflammation is associated with inducible ischemia in patients with stable coronary disease is unknown.

Methods and Results— We recruited patients with known coronary disease from 2 VA Medical Centers and 1 University-based medical center for the Heart and Soul Study. We measured CRP levels in 118 participants who had exercise-induced ischemia and in 111 who did not have inducible ischemia, as determined by stress echocardiography. We used logistic regression to examine the risk of exercise-induced ischemia associated with elevated CRP. We found that 75% (39/52) of participants in the highest CRP category (>0.38 mg/dL) had inducible ischemia, compared with 45% (79/177) in the lower 4 categories combined (adjusted odds ratio 4.2; 95% confidence interval 1.6 to 11; P=0.004). However, this association differed in users and nonusers of ß-blockers and statins. Among 89 participants who did not use ß-blockers, 93% in the highest CRP category had exercise-induced ischemia, compared with 42% in the lower 4 categories (P=0.03). Among 67 participants who did not use statins, 94% in the highest CRP category had exercise-induced ischemia, compared with 44% in the lower 4 categories (P=0.009). We did not observe a significant association between CRP and ischemia among participants who were treated with either of these medications.

Conclusion— Elevated CRP levels are associated with inducible ischemia in patients with stable coronary disease, particularly among those not treated with ß-blockers or statins.

Key Words: coronary disease • ischemia • risk factors • inflammation • epidemiology

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