Full research paper The prevalence and predictors of elevated C-reactive protein after a coronary heart disease event John Munkhaugen 1,2 , Jan Erik Otterstad 3 , Toril Dammen 2 , Erik Gjertsen 1 , Torbjørn Moum 2 , Einar Husebye 1 and Lars Gullestad 4 Abstract Objective: An interleukin-beta antagonist reduces the risk of subsequent cardiovascular events in coronary patients with high-sensitivity C-reactive protein (hs-CRP) 2 mg/L. It remains to be defined how large the coronary population at inflammatory risk is, and what the predictors of elevated risk are. Methods: A cross-sectional study investigated the proportion of patients with elevated hs-CRP (i.e. 2 mg/L) and the respective demographic and clinical predictors in 971 patients without concomitant inflammatory diseases who had been hospitalized with myocardial infarction (80%) and/or a revascularization procedure. Data were collected from hospital records, a self-report questionnaire and a clinical examination with blood samples. Results: After 2–36 month follow-up, 39% (n ¼ 378) had hs-CRP  2 mg/L, among whom 64% (n ¼ 243) had low-density lipoprotein cholesterol (LDL-C) 1.8 mmol/L and 47% (n ¼ 176) used a low-intensity statin regime. Only 24% had both LDL and hs-CRP at target range, 27% had elevation of both, whereas 12% had hs-CRP  2 mg/L and LDL-C < 1.8 mmol/L. Somatic comorbidity (odds ratio (OR) 1.3/1.0 point on the Charlson score), 1 previous coronary event (OR 2.4), smoking (OR 2.2), higher body mass index (OR 1.2/1.0 kg/m 2 ), high LDL-C (OR 1.4/1.0 mmol/L) and higher anxiety scores (OR 1.1/1.0 point increase on the Hospital Anxiety and Depression Scale-Anxiety subscale score) were signifi- cantly associated with hs-CRP 2 mg/L in adjusted analyses. Conclusions: Elevated hs-CRP was frequently observed after a coronary event and associated with unfavourable LDL-C and unhealthy lifestyles and psychosocial distress. Intensified statin therapy and strategies to target these modifiable factors are the encouraged first steps to reduce inflammation and improve LDL-C in these patients. Keywords High-sensitivity C-reactive protein, prevalence, predictors, secondary prevention, coronary heart disease, low-density lipoprotein cholesterol, statin therapy, risk factor control, demographic factors, psychosocial factors Received 7 December 2017; accepted 14 March 2018 Introduction The pivotal and independent role of low-grade inflammation for the development and progression of atherosclerosis is recognized in clinical and patho- physiological studies, and high-sensitivity C-reactive protein (hs-CRP) has been a robust marker of low- grade inflammation. 1,2 Statins are the cornerstone drug treatment in secondary prophylaxis after cardio- vascular events, with a strong scientific documentation on prevention of subsequent events and improvement of cardiac prognosis. 3 Evidence from randomized trials in coronary heart disease (CHD) patients has shown 1 Department of Medicine, Drammen Hospital, Vestre Viken Trust, Norway 2 Department of Behavioural Sciences in Medicine and the Faculty of Medicine, University of Oslo, Norway 3 Department of Cardiology, Vestfold Hospital Trust, Norway 4 Department of Cardiology, Oslo University Hospital Rikshospitalet and the Faculty of Medicine, University of Oslo, Norway Corresponding author: John Munkhaugen, Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 48, 3004 Drammen, Norway. Email: johmun@vestreviken.no European Journal of Preventive Cardiology 0(00) 1–9 ! The European Society of Cardiology 2018 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2047487318768940 journals.sagepub.com/home/ejpc