The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.
SMJ // Article
Review Article
Role of hs-CRP in Post-MI Sequelae: Insights into Mechanisms and Clinical Significance
Abstract
High-sensitivity C-reactive protein (hs-CRP) is a key marker of inflammation, predominantly produced by hepatocytes and various tissues, including intracardiac tissue, atherosclerotic plaques, and vascular smooth muscles. The biomarker serves as a crucial element of innate immunity and rises in response to various disease processes, including infections and cancers. This rise is triggered by the release of cytokines, primarily interleukin-6, tumor necrosis factor, and interleukin-1β. The utility of hs-CRP in clinical practice is being further explored, particularly regarding its role in cardiovascular disease, a leading cause of morbidity and mortality globally. Studies have demonstrated that elevated hs-CRP levels are associated with an increased risk of myocardial infarction (MI) and other cardiovascular events. hs-CRP has been suggested to play a role in the development of atrial and ventricular arrhythmias post-MI, although further research is needed to fully clarify this relationship. hs-CRP has been proposed as a potential biomarker for the early detection of post-MI events and be used for cardiovascular disease risk stratification, categorizing individuals into low-, intermediate-, and high-risk groups. In this study, we discuss the role of hsCRP in predicting adverse outcomes in various cardiovascular conditions, highlighting its potential as a valuable biomarker in clinical practice.Posted in: Cardiovascular Disease51
This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Ralapanawa U, Kumarasiri PVR, Jayawickreme KP, et al. Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka. BMC Cardiovasc Disord 2019;19:229.
2. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey homepage. https://www.cdc.gov/nchs/nhanes/. Accessed May 3, 2025.
3. De Souza Santos I, Goulart AC, Brandão R, et al. One-year mortality after an acute coronary event and its clinical predictors: the ERICO study. Arq Bras Cardiol 2015;105:53–64.
4. Jacob R, Khan M. Cardiac biomarkers: what is and what can be. Indian J Cardiovasc Dis Women 2018;3:240-244.
5. Patibandla S, Gupta K, Alsayouri K. Cardiac biomarkers. In: StatPearls. NCBI Bookshelf version. StatPearls Publishing: 2023. Accessed May 3, 2025. https://www.ncbi.nlm.nih.gov/books/NBK545216/.
6. Sheikh AS, Yahya S, Sheikh NS, et al. C-reactive protein as a predictor of adverse outcome in patients with acute coronary syndrome. Heart Views 2012;13:7-12.
7. Rezayi M, Sany SBT, Rahimi HR, et al. Serum C-reactive protein in the prediction of cardiovascular diseases: overview of the latest clinical studies and public health practice. J Cell Physiol 2018;233:8508-8525.
8. Han E, Fritzer-Szekeres M, Szekeres T, et al. Comparison of high-sensitivity C-reactive protein vs C-reactive protein for cardiovascular risk prediction in chronic cardiac disease. J Appl Lab Med 2022;7:1259-1271.
9. Vanhaverbeke M, Veltman D, Pattyn N, et al. C-reactive protein during and after myocardial infarction in relation to cardiac injury and left ventricular function at follow-up. Clin Cardiol 2018;41:1201-1206.
10. Fonseca FAH, De Oliveira Izar MC. High-sensitivity C-reactive protein and cardiovascular disease across countries and ethnicities. Clinics (Sao Paolo) 2016;71:235-242.
11. Aseri ZA, Habib SS, Marzouk A. Predictive value of high sensitivity C-reactive protein on progression to heart failure occurring after the first myocardial infarction. Vasc Health Risk Manag 2019;15:221-227.
12. Li Y, Zhang X, Cheng G, et al. hs-CRP and all-cause, cardiovascular, and cancer mortality risk: a meta-analysis. Atherosclerosis 2017;259:75-82.
13. Banait T, Wanjari A, Danade V, et al. Role of high-sensitivity C-reactive protein (HS-CRP) in non-communicable diseases: a review. Cureus 2022;14:e30225.
14. Taube A, Schlich R, Sell H, et al. Inflammation and metabolic dysfunction: links to cardiovascular diseases. Am J Physiol Heart Circ Physiol 2012;302:H2148-H2165.
15. Trujillo ME, Scherer PE. Adipose tissue-derived factors: impact on health and disease. Endocr Rev 2006;27:762-778.
16. Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol 2018:9:754.
17. Zhu J, Song W, Hu Z, et al. Traditional Chinese medicine’s intervention in endothelial nitric oxide synthase activation and nitric oxide synthesis in cardiovascular system. Chin J Integr Med, published online February 10, 2015, doi:10.1007/s11655-015-1964-1.
18. Iida K, Tani S, Atsumi W, et al. Association of plasminogen activator inhibitor-1 and low-density lipoprotein heterogeneity as a risk factor of atherosclerotic cardiovascular disease with triglyceride metabolic disorder. Coron Artery Dis 2017;28:577-587.
.
19. Kamath D, Xavier D, Sigamani A, et al. High sensitivity C-reactive protein (hsCRP) & cardiovascular disease: an Indian perspective. Indian J Med Res 2015;142:261.
20. Parrinello CM, Lutsey PL, Ballantyne CM, et al. Six-year change in high-sensitivity Creactive protein and risk of diabetes, cardiovascular disease, and mortality. Am Heart J 2015; 170:380-389.
21. Lee HS, Lee JH. Early elevation of high-sensitivity C-reactive protein as a predictor for cardiovascular disease incidence and all-cause mortality: a landmark analysis. Sci Rep 2023; 13:14118.
22. Duchnowski P, Szymański P, Kuśmierczyk M, et al. High-sensitivity C-reactive protein as a prognostic marker in patients undergoing valve surgery. Kardiochir Torakochirurgia Pol 2020;17:15-19.
23. Polyakova E, Mikhaylov EN. The prognostic role of high-sensitivity C-reactive protein in patients with acute myocardial infarction. J Geriatr Cardiol 2020;17:379–383.
24. Kobayashi Y, Tanno K, Ueno A, et al. In-Hospital electrical storm in acute myocardial infarction―clinical background and mechanism of the electrical instability. Circ J 2018;83: 91-100.
25. Kalkman DN, Aquino M, Claessen BE, et al. Residual inflammatory risk and the impact on clinical outcomes in patients after percutaneous coronary interventions. Eur Heart J 2018;39: 4101-4108.
26. Berezin AЕ, Berezin AA. Adverse cardiac remodelling after acute myocardial infarction: old and new biomarkers. Dis Markers 2020;2020:1215802.
27. Ridker PM, Köenig W, Kastelein JJP, et al. Has the time finally come to measure hs-CRP universally in primary and secondary cardiovascular prevention? Eur Heart J 2018;39: 4109-4111.
28. Bouzidi N, Messaoud MB, Maatouk F, et al. Relationship between high sensitivity C-reactive protein and angiographic severity of coronary artery disease. J Geriatr Cardiol 2020;17: 256–263.
29. Carrero JJ, Franko MA, Obergfell A, et al. hsCRP level and the risk of death or recurrent cardiovascular events in patients with myocardial infarction: a healthcare-based study. J Am Heart Assoc 2019;8:e012638.
30. Pellicori P, Zhang J, Cuthbert J, et al. High-sensitivity C-reactive protein in chronic heart failure: patient characteristics, phenotypes, and mode of death. Cardiovasc Res 2019;116: 91-100.
31. Anand IS, Latini R, Florea VG, et al. C-reactive protein in heart failure. Circulation 2005;112: 1428-1434.
32. Bogaty P, Boyer L, Simard S, et al. Clinical utility of C-reactive protein measured at admission, hospital discharge, and 1 month later to predict outcome in patients with acute coronary disease. J Am Coll Cardiol 2008;51:2339-2346.
33. Mester A, Rat N, Benedek T, et al. Acute-phase inflammatory reaction predicts CMR myocardial scar pattern and 2-year mortality in STEMI patients undergoing primary PCI. J Clin Med 2022;11:1222.
34. Habibi D, Daneshpour MS, Asgarian S, et al. Effect of C-reactive protein on the risk of heart failure: a mendelian randomization study. BMC Cardiovasc Disord 2023;23:112.
35. Larsen KK. Depression following myocardial infarction. Dan Med J 2013;60:B4689.
36. Cubero-Gallego H, Romaguera R, Ariza-Sole A, et al. Revascularization strategies in patients with ST-segment elevation myocardial infarction and multi-vessel coronary artery disease: urgent or staged? Cardiovasc Diagn Ther 2017;7(Suppl 2):S82-S85.
37. Dhar AK, Barton DA. Depression and the link with cardiovascular disease. Front Psychiatry 2016:7:33.
38. Alizadeh P, Bahramali E, Hedayati A, et al. Anticipation of high-sensitivity C-reactive protein effect on post myocardial infarction depression disorder. Galen Med J 2021;10:e1512.
39. Hammadah M, Sullivan S, Pearce B, et al. Inflammatory response to mental stress and mental stress induced myocardial ischemia. Brain Behav Immun 2018;68:90-97.
40. Shah R, Burg MM, Vashist A, et al. C-reactive protein and vulnerability to mental stress-induced myocardial ischemia. Mol Med 2006;12:269-274.
41. Ridker PM, Rifai N. C-Reactive Protein and Cardiovascular Disease. Saint-Laurent, QC, Canada: MediEdition; 2006.
42. Alyan O, Metin F, Kacmaz F, et al. High levels of high sensitivity C-reactive protein predict the progression of chronic rheumatic mitral stenosis. J Thromb Thrombolysis 2008;28:63-69.
43. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation. Circulation 2014;129:837-847.
44. Aronson D, Boulos M, Suleiman A, et al. Relation of C-reactive protein and new-onset atrial fibrillation in patients with acute myocardial infarction. Am J Cardiol 2007;100:753-757.
45. Ren Y, Zeng RX, Li JJ, et al. Relation of C-reactive protein and new-onset atrial fibrillation in patients with acute myocardial infarction: a systematic review and meta-analysis. Int J Cardiol 2015;190:268-270.
46. Gu H, Yang K, Lin J, et al. Association between high-sensitivity C-reactive protein, functional disability, and stroke recurrence in patients with acute ischaemic stroke: a mediation analysis. EBioMedicine 2022;80:104054.
47. Zhou Y, Han W, Gong D, et al. hs-CRP in stroke: a meta-analysis. Clin Chim Acta 2016;453: 21-27.
48. Salazar JC, Martínez MS, Chávez-Castillo M, et al. C-reactive protein: an in-depth look into structure, function, and regulation. Int Sch Res Notices 2014;2014:653045.
