Increased hsCRP is associated with higher risk of aortic valve replacement in patients with aortic stenosis

Objective To investigate relations between inflammation and aortic valve stenosis (AS) by measuring high-sensitivity C-reactive protein, at baseline (hsCRP₀) and after 1 year (hsCRP₁) and exploring associations with aortic valve replacement (AVR). Design We examined 1423 patients from the Simvastatin and Ezetimibe in Aortic Stenosis study. Results During first year of treatment, hsCRP was reduced both in patients later receiving AVR (2.3 [0.9–4.9] to 1.8 [0.8–5.4] mg/l, p < 0.001) and not receiving AVR (1.90 [0.90–4.10] to 1.3 [0.6–2.9] mg/l, p <0.001). In Cox-regression analyses, hsCRP₁ predicted later AVR (HR = 1.17, p < 0.001) independently of hsCRP₀ (HR = 0.96, p = 0.33), aortic valve area (AVA) and other risk factors. A higher rate of AVR was observed in the group with high hsCRP₀ and an increase during the first year (AVR_{highCRP0CRP1inc}=47.3% versus AVR_{highCRP0CRP1dec}=27.5%, p < 0.01). The prognostic benefit of a 1-year reduction in hsCRP was larger in patients with high versus low hsCRP₀ eliminating the difference in incidence of AVR between high versus low hsCRP₀ (AVR_{highCRP0CRP1dec}=27.5% versus AVR_{lowCRP0CRP1dec}=25.8%, p = 0.66) in patients with reduced hsCRP during the first year. Conclusions High hsCRP₁ or an increase in hsCRP during the first year of follow-up predicted later AVR independently of AVA, age, gender and other risk factors, although no significant improvement in C-statistics was observed.