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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2009;29:1691.)
© 2009 American Heart Association, Inc.

Clinical and Population Studies

Carotid Intima-Media Thickness, Systemic Inflammation, and Incidence of Heart Failure Hospitalizations

Gunnar Engström; Olle Melander; Bo Hedblad

From the Department of Clinical Sciences in Malmö, Lund University, Malmö University Hospital, Sweden.

Correspondence to Prof Gunnar Engström, Cardiovascular Epidemiology Research group, UMAS, CRC, bld 60:13, 20502 Malmö, Sweden. E-mail Gunnar.Engstrom{at}med.lu.se

Objectives— This study explored the relationships between carotid intima-media thickness (IMT), plasma levels of C-reactive protein (CRP), and incidence of heart failure hospitalizations.

Methods and Results— Men and women from the general population (n=4691), without history of myocardial infarction or stroke, were examined. Incidence of hospitalizations attributable to heart failure was studied over a mean follow-up of 13 years. A total of 75 subjects were hospitalized with a primary diagnosis of heart failure. Adjusted for risk factors, the hazards ratios (95% CI) were 1.00, 0.98 (0.36 to 2.7), 1.9 (0.80 to 4.6), and 2.7 (1.1 to 6.2), respectively, for the 1st, 2nd, 3rd, and 4th quartiles of IMT (P for trend=0.003). The HR associated with CRP levels 3 mg/L (versus <1 mg/L) was 2.0 (95% CI: 1.06 to 3.9) after adjustments for risk factors. There was a significant interaction between IMT and CRP on heart failure incidence (P=0.028). Subjects with CRP 3 mg/L and IMT in the 4th quartile had an adjusted HR of 3.7 (1.9 to 7.1) compared to those with CRP <3 mg/L and IMT in quartile 1 to 3.

Conclusion— High IMT and high CRP are both independent risk factors for incidence of heart failure requiring hospitalization. The joint exposure to both risk factors substantially increases the risk.

Incidence of heart failure was studied in 4691 men and women without history of myocardial infarction or stroke. High carotid intima-media thickness (IMT) and high C-reactive protein (CRP) levels were independent risk factors for future heart failure requiring hospitalization. The joint exposure to both risk factors substantially increased the risk.

Key Words: heart failure • atherosclerosis • inflammation • epidemiology