George Dangas, MD, PhD: Inflammatory Risk in PCI Patients

What were the findings of a large, single-center registry assessment for inflammation in patients with low LDL-C?

A recent study from investigators at Mount Sinai Health System showed that residual inflammatory risk in low LDL-cholesterol patients undergoing percutaneous coronary intervention could be an indicator for risk to major adverse cardiac and cerebrovascular accidents including death, myocardial infarction, or stroke.

In discussing the findings with MD Magazine®, study author George Dangas, MD, PhD, a professor of Cardiology at the Mount Sinai School of Medicine, discussed what makes inflammation a relatively early-evidenced but interesting risk factor for cardiovascular events.

MD Mag: What was found when assessing for inflammatory risk in patients with low LDL-cholesterol?

Dangas: The interesting part about this study is that we managed to access patient data that includes measurement of inflammation markers—CRP, specifically—over a period of time. More studies thus far have assessed the importance of CRP in a single measurement.

Interestingly of course, these biomarkers in the blood sort of fluctuate over time. So we set out to study what it means for someone to have a CRP that’s maybe high in baseline, but then it may either convert to low or remain high, and follow up. And this is kind of over a month or so apart. So we're not really talking about CRP over the same hospitalization, but CRP away from the acute event.

So interestingly we found 4 mathematical possibilities: high-high, high-low, low-high, and low-low. Aside from these 4 possibilities that are mathematically possible, we found that, in general, to have a high CRP at any time is not so good, and that people who convert into high from low are also not in good shape. My immediate message is, “Hold on, CRP fluctuates quite a bit over time.”

I'd like to know that, and in my own practice, I would say that the measurement of CRP over time may be a year apart sometimes—or if for any reason shorter, could be another way that I would assess the long-term risk of my patients.

And that would be yet another piece in this puzzle how they are doing after an event that they had.

How will these findings affect real-world patient care practice?

Typically in the follow-ups with patients with heart disease, we check their cholesterol levels quite frequently for both safety reasons, as well as for efficacy reasons—to make sure the medications work, and to make sure the levels are on target, as well as to monitor the patient's compliance.

So far, the levels of inflammation have been a marker of how well people do in general terms. Just only last year, there was a study indicating that a specific inflammation inhibitor may improve patient outcomes. But again, due to various reasons this hasn't come to market, and there isn't much specifically to do.

So this way, based on our results, I think through monitored inflammation for the longer term and seeing how that goes as a secondary factor of cholesterol medications, secondary effect of exercise, and perhaps other lifestyle measurements the patients take, we can see how the patient assessment may be affected by this result. And we can add another way to monitor patients wellbeing over time.