BURDEN OF ILLNESS IN PATIENTS WITH ELEVATED HIGH-SENSITIVITY C-REACTIVE PROTEIN LEVELS AND A HISTORY OF MYOCARDIAL INFARCTION- A TARGETED LITERATURE REVIEW
Author(s)
Jindal R1, Agrawal R1, Gabrielsen A2, Deschaseaux C3
1Novartis Healthcare Pvt. Ltd., Hyderabad, India, 2Novartis Sverige AB, Täby, Sweden, 3Novartis Pharma AG, Basel, Switzerland
OBJECTIVES: The inflammatory marker C-reactive protein (CRP) can be measured in a high-sensitivity assay (hs-CRP) specific to cardiac inflammation. We aimed to evaluate published literature on the clinical, economic, and humanistic burden in patients with a history of myocardial infarction (MI) and elevated levels of CRP. METHODS: A comprehensive literature search was performed for publications in English between January 2000 and February 2016 in MEDLINE, EMBASE, and MEDLINE In-Process. Search terms were variations on ‘Post myocardial infarction’, ‘CRP’ and ‘burden’. Clinical and real-world studies reporting baseline CRP levels in patients with a history of MI were included in the analysis. Burden of illness (BOI) was defined as death, CV events, quality of life (QoL), healthcare utilisation, disability, productivity loss, hospitalisations or patient-reported outcomes. RESULTS: Eight studies met the inclusion criteria. Cut-off points in hs-CRP assays varied from >2 mg/L to ≥5.9 mg/L. Five of six publications reporting on CV events found elevated CRP levels to be predictive of future risk. Elevated CRP levels independently predicted all-cause mortality in four studies and CV mortality in three studies. Three publications included data on comorbidities:. Diabetes was associated with elevated CRP in two of three analyses; hypertension in one out of two. No consistent associations between elevated CRP levels and hyperlipidaemia (one report), stroke or angina pectoris (one report) were found. No study reported economic BOI, resource use or QoL. CONCLUSIONS: Limited data are available on BOI in patients with a history of MI and elevated CRP levels. Although variations in findings, cut-off points and methods between studies make generalisations difficult, increased CRP levels appear to be associated with an increased risk of CV events, all-cause mortality and CV mortality. A longitudinal study may be valuable to further assess the role of the hs-CRP assay in risk stratification in secondary prevention following MI.
Conference/Value in Health Info
2016-10, ISPOR Europe 2016, Vienna, Austria
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PCV7
Topic
Clinical Outcomes, Epidemiology & Public Health
Topic Subcategory
Relating Intermediate to Long-term Outcomes
Disease
Cardiovascular Disorders