High-sensitivity C-reactive protein (hs-CRP) is predictive of future cardiovascular events in apparently healthy individuals but its role in heart failure has not been extensively studied.

In the Valsartan Heart Failure Trial (Val-HeFT), the efficacy and safety of the angiotensin receptor blocker valsartan versus placebo was evaluated in over 5,000 patients with NYHA class II-IV heart failure, and hs-CRP was measured at baseline and at several timepoints during follow-up. The aims were to evaluate the prognostic value of hs-CRP in patients with heart failure, and to see whether hs-CRP adds to the prognostic information obtained from brain natriuretic peptide (BNP) in heart failure.

The Val-HeFT findings supported previous studies in that BNP was the strongest predictor of heart failure mortality and morbidity. Can CRP add to the prognostic information of BNP in these patients? This study found that CRP did add incremental prognostic information to that provided by BNP alone. Higher hs-CRP levels were associated with a worse hemodynamic and neurohormonal profile and poorer quality of life, and were independently predictive of mortality and morbidity (1). Dr. Anand also talks about how CRP lowering with valsartan was affected by ACE inhibitor use.

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After viewing this presentation the participant will be able to discuss:

- Valsartan Heart Failure Trial study design
- Prognostic value of BNP and CRP in heart failure
- Factors associated with high hs-CRP levels in heart failure
- Evidence for CRP lowering with valsartan

1. Inder S. Anand, MD, FRCP, DPhil (Oxon); Roberto Latini, MD; Viorel G. Florea, MD; Michael A. Kuskowski, PhD; Thomas Rector, PhD; Serge Masson, PhD; Stefano Signorini, BiolD; Paolo Mocarelli, MD; Allen Hester, PhD; Robert Glazer, MD; Jay N. Cohn, MD, for the Val-HeFT InvestigatorsC-Reactive Protein in Heart Failure: Prognostic Value and the Effect of Valsartan Circulation. 2005;112:1428-1434.