Determination of C-reactive protein (CRP) level has been suggested to improve cardiovascular disease (CVD) risk assessment. This study examines the utility of CRP levels to assess CVD risk in a community setting.
We performed a prospective observational cohort study on a community population sample. A total of 1949 men and 2497 women without CVD from the Framingham Heart Study underwent CVD risk factor assessment. Initial CVD events during 8 years of follow-up were recorded.
There were 283 major CVD and 160 major coronary heart disease incident events. Age-, sex-, and multivariable-adjusted analyses generally used CRP level categories of less than 1, 1 to 3, and greater than 3 mg/L. In age- and sex-adjusted models, the traditional risk factors and elevated CRP levels indicated increased risk. The age- and sex-adjusted relative risk (RR) and 95% confidence interval (CI) of CRP level greater than 3 mg/L for major CVD was elevated (RR, 1.60; 95% CI, 1.19-2.14), with evidence of attenuation (RR, 1.22; 95% CI, 0.90-1.66) in multivariable models. The C statistic, a measure of the discriminatory capability of the prediction models, was 0.74 for prediction of major CVD with age and CRP level. In multivariable models that included traditional risk factors, the C statistic was 0.78, a value that was unchanged with the addition of CRP to the multivariable model. Similar relations were noted for major coronary heart disease events.
Elevated CRP level provided no further prognostic information beyond traditional office risk factor assessment to predict future major CVD and major coronary heart disease in this population sample.
"Collectively, inclusion of these biomarkers was more informative for improving risk estimation, in contrast to single marker determination. Foremost, the clinical utility of individual biomarkers towards predicting subsequent cardiovascular events has recently been questioned   , which has led to several investigations to explore the usefulness of a multi-marker approach towards predicting cardiovascular risk estimation. For instance, Blankenberg and colleagues  evaluated 30 novel biomarkers representing distinct pathophysiological pathways among 2-middle-aged European cohorts. "
[Show abstract][Hide abstract] ABSTRACT: Background:
Conventional factors do not fully explain the distribution of cardiovascular outcomes. Biomarkers are known to participate in well-established pathways associated with cardiovascular disease, and may therefore provide further information over and above conventional risk factors. This study sought to determine whether individual and/or combined assessment of 9 biomarkers improved discrimination, calibration and reclassification of cardiovascular mortality.
3267 patients (2283 men), aged 18-95 years, at intermediate-to-high-risk of cardiovascular disease were followed in this prospective cohort study. Conventional risk factors and biomarkers were included based on forward and backward Cox proportional stepwise selection models.
During 10-years of follow-up, 546 fatal cardiovascular events occurred. Four biomarkers (interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D) were retained during stepwise selection procedures for subsequent analyses. Simultaneous inclusion of these biomarkers significantly improved discrimination as measured by the C-index (0.78, P = 0.0001), and integrated discrimination improvement (0.0219, P<0.0001). Collectively, these biomarkers improved net reclassification for cardiovascular death by 10.6% (P<0.0001) when added to the conventional risk model.
In terms of adverse cardiovascular prognosis, a biomarker panel consisting of interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D offered significant incremental value beyond that conveyed by simple conventional risk factors.
International journal of cardiology 04/2013; 168(3). DOI:10.1016/j.ijcard.2013.03.043 · 4.04 Impact Factor
"Fair-quality studies Ridker et al, 1997 (48) Danesh et al, 2000 (18) Gram et al, 2000 (54) Park et al, 2002 (28) van der Meer et al, 2003 (50) Witherell et al, 2003 (51) Danesh et al, 2004 (19) Lawlor et al, 2005 (35) Wilson et al, 2005 (43) Koenig et al, 2006 (59) Tuomisto et al, 2006 (62) Tzoulaki et al, 2007 (63) "
[Show abstract][Hide abstract] ABSTRACT: C-reactive protein (CRP) may help to refine global risk assessment for coronary heart disease (CHD), particularly among persons who are at intermediate risk on the basis of traditional risk factors alone.
To assist the U.S. Preventive Services Task Force (USPSTF) in determining whether CRP should be incorporated into guidelines for CHD risk assessment.
MEDLINE search of English-language articles (1966 to November 2007), supplemented by reference lists of reviews, pertinent studies, editorials, and Web sites and by expert suggestions.
Prospective cohort, case-cohort, and nested case-control studies relevant to the independent predictive ability of CRP when used in intermediate-risk persons.
Included studies were reviewed according to predefined criteria, and the quality of each study was rated.
The validity of the body of evidence and the net benefit or harm of using CRP for CHD risk assessment were evaluated. The combined magnitude of effect was determined by meta-analysis. The body of evidence is of good quality, consistency, and applicability. For good studies that adjusted for all Framingham risk variables, the summary estimate of relative risk for incident CHD was 1.58 (95% CI, 1.37 to 1.83) for CRP levels greater than 3.0 mg/L compared with levels less than 1.0 mg/L. Analyses from 4 large cohorts were consistent in finding evidence that including CRP improves risk stratification among initially intermediate-risk persons. C-reactive protein has desirable test characteristics, and good data exist on the prevalence of elevated CRP levels in intermediate-risk persons. Limited evidence links changes in CRP level to primary prevention of CHD events.
Study methods for measuring Framingham risk variables and other covariates varied. Ethnic and racial minority populations were poorly represented in most studies, limiting generalizability. Few studies directly assessed the effect of CRP on risk reclassification in intermediate-risk persons.
Strong evidence indicates that CRP is associated with CHD events. Moderate, consistent evidence suggests that adding CRP to risk prediction models among initially intermediate-risk persons improves risk stratification. However, sufficient evidence that reducing CRP levels prevents CHD events is lacking.
Annals of internal medicine 10/2009; 151(7):483-95. DOI:10.7326/0003-4819-151-7-200910060-00009 · 17.81 Impact Factor
"According to these authors (Danesh et al., 2004), CRP is a relatively moderate predictor of coronary heart disease. The results of our investigation do not support the data of the authors cited above (Ridker, 2003; Danesh et al., 2004; Wilson et al., 2005; Smith et al., 2006). We did not fi nd that the results of C-reactive protein investigation were in accordance with the data of the classical plasma atherosclerosis indices. "
[Show abstract][Hide abstract] ABSTRACT: Garlic and white and red varieties of onion were subjected to processing by a variety of culinary methods, and bioactive compounds then determined. For in vivo studies, 84 male Wistar rats were randomly divided into 14 diet groups, each of six rats, including two control groups (one with no supplementation and one with cholesterol supplementation only). During the 30-day trial, the basal diets of the other 12 groups were supplemented with 1% cholesterol and raw or processed vegetables. Both raw red onion and red onion subjected to blanching for 90 s hindered the rise in plasma lipids more than the other vegetables studied in the supplemented diets. The decrease in antioxidant activity compared to the cholesterol-supplemented control group was significantly less for the group fed with red onion subjected to blanching for 90 s. No histological changes were detected in the studied organs of rats that had been fed cholesterol. In conclusion, blanching for 90 s most fully preserved the bioactive compounds and antioxidant potentials, and hindered the rise in plasma lipid levels and the decrease in plasma antioxidant activity of rats fed cholesterol. Alkaline phosphatase levels correlated with classical atherosclerosis indices, and determination of alkaline phosphatase is suggested as an additional index in atherosclerosis testing.
Phytotherapy Research 01/2009; 24(5):706-14. DOI:10.1002/ptr.3001 · 2.66 Impact Factor
Hassan Alkhawam, Feras Zaiem, Robert Sogomonian, Mohammed El-Hunjul, Mohamad Al-Kateb, M Umair Bakhsh, Raef Madanieh
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