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Peter Bogaty, MD; James M. Brophy, MD, PhD; Luce Boyer, RN; Serge Simard, MSc; Lawrence Joseph, PhD; Fernand Bertrand, BSc; Gilles R. Dagenais, MD

Arch Intern Med. 2005;165:221-226.

Background  C-reactive protein (CRP), a marker of inflammation, is increasingly measured to stratify coronary artery disease risk and guide clinical management. However, little is known about how inflammatory markers fluctuate over time in patients with stable ischemic heart disease.

Methods  We examined serial serum CRP values in 159 patients with histories spanning the clinical spectrum of ischemic heart disease. Two to 8 CRP measurements were made at intervals varying from 15 days to 6 years. Successive interleukin (IL)-6 values were examined in 1 subgroup. Blood samples were always taken when patients were clinically stable, in the absence of any potentially confounding inflammatory condition.

Results  C-reactive protein values in individual patients fluctuated considerably when examined in the following ranges: less than 1 mg/L, 1 to 3 mg/L, and greater than 3 mg/L, proposed to indicate low, average, and high risk. Sixty-four patients (40.3%) changed risk category between the first and the second measurement. Within-patient variances of CRP and IL-6 levels were 1.79 mg/L (95% confidence interval, 1.60-2.00) and 2.69 pg/mL (95% confidence interval, 2.29-3.18), respectively. The variability of CRP was consistent over different times and across clinical groups, and independent of body mass index, smoking status, medication, and clinical events.

Conclusions  Relatively important fluctuations in CRP levels in patients with stable ischemic heart disease may be problematic for risk stratification and treatment monitoring. A similar IL-6 variability suggests that these patients have a dynamic inflammatory status whose kinetics may modulate acute coronary risk.

Author Affiliations: Quebec Heart Institute/Laval Hospital, Laval University, Quebec City (Drs Bogaty and Dagenais, Ms Boyer, and Messrs Simard and Bertrand); Royal Victoria Hospital (Dr Brophy) and Department of Epidemiology and Biostatistics (Dr Joseph), McGill University, Montreal; and Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec (Dr Joseph).

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