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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.

Sec. Cardiovascular Epidemiology and Prevention

Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1554897

Relationship Between Recurrently Elevated hsCRP and Adverse Cardiovascular Events among Depressed Patients in China: A Time-to-Event Analysis

Provisionally accepted
  • 1Ningbo University, Ningbo, China
  • 2Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo, Zhejiang Province, China
  • 3Ningbo First Hospital, Ningbo, Zhejiang Province, China

The final, formatted version of the article will be published soon.

Context:Persistent inflammation has been considered a biological link between depression and cardiovascular diseases(CVDs). Multipoint assessments of inflammation provide a more reasonable understanding of an individual's inflammatory status compared to single-point measurements. However, few studies have established strategies to investigate multipoint measurements of plasma high-sensitivity C-reactive protein(hsCRP). Aims/Objective/Hypothesis: To elucidate the association between recurrent elevations in hsCRP and cardiovascular events among depressed patients. Methods: This retrospective cohort study analyzed medical records over a ten-year follow-up to evaluate the association between longitudinal hsCRP patterns and recurrent cardiovascular events in patients with depression. An age-adjusted gamma frailty time-to-event model was used to assess the risk for three primary outcomes: chronic ischemic heart disease (CIHD), atrial fibrillation (AF) and other arrhythmias, and major adverse cardiac events (MACE). The cumulative incidence of these recurrent events was estimated using the Mean Cumulative Function (MCF). Results: The study included 10770 patients (7428 [68.97%] females). Patients were classified into five groups based on hsCRP levels: hsCRP < 3mg/L (n=4209, 39.08%), 3-8mg/L (n=1697, 15.76%), one measurement of hsCRP ≥ 8mg/L (n=3007, 27.92%), two to three measurements of hsCRP ≥ 8mg/L (n=1349, 12.53%), and >3 measurements of hsCRP ≥ 8 mg/L (n=508, 4.72%). The MCFs for CIHD across the five groups were 1.156, 1.339, 1.417, 2.021, and 2.36, respectively. For AF and other arrhythmias, the corresponding MCFs were 0.796, 1.369, 1.008, 0.858, and 1.578, while for MACE, they were 0.084, 0.089, 0.134, 0.196, and 0.172. Compared with the reference group (hsCRP < 3mg/L), the adjusted hazard ratios (HRs) for CIHD were 1.28 (P=0.14), 1.19 (P=0.17), 1.70 (P<0.001), and 1.88 (P<0.001) across the other four groups; for AF and other arrhythmias, they were 1.38 (P=0.07), 1.00 (P=0.99), 1.04 (P=0.84), and 1.83 (P<0.01); and for MACE, they were 0.85 (P=0.65), 0.73 (P=0.24), 1.21 (P=0.49), and 1.28(P=0.40), respectively. Conclusions: The gamma frailty time-to-event model indicated a link between persistent inflammation and cardiac events. Recurrent hsCRP elevations were more strongly associated with cardiovascular events than those observed in cross-sectional analyses.

Keywords: hsCRP, Inflammation, Depression, Time-to-event analysis, adversecardiovascular events

Received: 03 Jan 2025; Accepted: 02 Oct 2025.

Copyright: © 2025 Wu, Mi, Cui, Song and Ruan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Lie-Min Ruan, 13805869162@163.com

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