C-reactive protein levels and coronary artery disease incidence and mortality in apparently healthy men and women: The EPIC-Norfolk prospective population study 1993-2003
ABSTRACT Measurement of C-reactive protein (CRP) levels has been proposed as a useful marker to improve the prediction of future coronary artery disease (CAD) risk, but this notion has been challenged recently.
We performed a prospective case-control study among apparently healthy men and women. The odds ratio (OR) for future CAD incidence was 2.49 (95% CI=2.02-3.08, p for linearity <0.0001) unadjusted, and 1.66 (95% CI=1.31-2.12, p for linearity <0.0001), after adjustment for classical cardiovascular risk factors, for top versus bottom quartile of the CRP distribution. Notably, the risk factor adjusted predictive value was substantially stronger for fatal CAD (OR=2.92, 95% CI=1.83-4.67, p for linearity <0.0001) than for non-fatal CAD (OR=1.25, 95% CI=0.93-1.66, p for linearity=0.06). CRP levels were among the strongest predictors of CAD incidence and mortality. CRP levels remained a statistically significant predictor of future CAD, even after adjustment for the Framingham risk score.
In this British cohort with risk factor levels representative of a contemporary Western population, CRP concentration was among the strongest predictors of CAD incidence and mortality. We suggest that current guidelines on CRP measurement in clinical practice should be based on contemporary and representative populations.
SourceAvailable from: Benoit Arsenault[Show abstract] [Hide abstract]
ABSTRACT: Several plasma non-lipid biomarkers have been shown to predict major cardiovascular events (MCVEs) in population studies. Our objective was to investigate the relationship between lipid and non-lipid biomarkers levels achieved during statin therapy and the incidence of MCVEs in patients with stable coronary heart disease (CHD). We conducted a substudy of the TNT (Treating to New Targets) study, which was a randomized trial that compared the efficacy of high (80 mg) versus low (10 mg) dose atorvastatin for the secondary prevention of CHD. Fasting plasma levels of standard lipids and of 18 non-lipid biomarkers were obtained after an 8-week run-in period on atorvastatin 10 mg in 157 patients who experienced MCVEs during the 4.9 years of study follow-up and in 1349 controls. MCVE was defined as CHD death, nonfatal, non-procedure-related myocardial infarction, resuscitated cardiac arrest, and fatal or nonfatal stroke. After adjusting for age, sex and treatment arm, plasma levels of high-density lipoprotein (HDL) cholesterol, triglycerides, high-sensitivity C-reactive protein (hsCRP), insulin, neopterin, N-terminal pro-brain natriuretic peptide (BNP), lipoprotein(a) [Lp(a)], and the soluble receptor for advanced glycation end products (sRAGE) were predictive of recurrent MCVEs (P≤0.02 for each doubling of plasma concentration). However, no significant association was observed between the risk of recurrent MCVEs and plasma levels of low-density lipoprotein cholesterol, adiponectin, cystatin C, lipoprotein-associated phospholipase A2, monocyte chemotactic protein-1, matrix metalloproteinase-9, myeloperoxidase, osteopontin, soluble CD40 ligand, soluble intercellular adhesion molecule-1, or soluble vascular cell adhesion molecule-1. After further adjustment for diabetes, hypertension, smoking, and BMI, the relationship between hsCRP, insulin and MCVE were no longer significant, while the relationship between Lp(a), neopterin, NT-proBNP and sRAGE and MCVE remained statistically significant. In conclusion, in patients with CHD treated with atorvastatin, plasma levels of Lp(a), neopterin, NT-proBNP, and sRAGE are associated with the risk of recurrent MCVEs. ClinicalTrials.gov NCT00327691.PLoS ONE 12/2014; 9(12):e114519. DOI:10.1371/journal.pone.0114519 · 3.53 Impact Factor
07/2014; 6(3):1-125. DOI:10.4199/C00110ED1V01Y201406ISP053
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ABSTRACT: Background: The objective of our study was to determine the respective contributions of waist circumference and systemic hypertension (HTN) to coronary heart disease (CHD) risk in a large population-based cohort representative of a contemporary European population. Methods and results: A total of 9580 men and 12 250 women aged 45-79 years were followed for 11.4 years. Over the follow-up, 2191 CHD events were recorded. After adjusting for traditional CHD risk factors, individuals with high blood pressure (BP) and high waist circumference were at an increased CHD risk [hazard ratio 3.04; 95% confidence interval (CI) 2.06-4.48 and 2.90 (1.85-4.55) in men and women, respectively], compared with individuals with both low waist circumference and BP. Among individuals with normal BP, those in the top waist circumference tertile were at an increased CHD risk compared with those in the bottom waist circumference tertile (hazard ratio 2.66; 95% CI 1.59-4.45 and 2.11; 95% CI 1.12-3.97 in men and women, respectively). Within each physical activity category, a linear positive association was observed between waist circumference tertiles and both SBP (P for trend <0.001) and DBP (P for trend <0.001). Within each waist circumference tertile, inactive individuals had higher SBP than active individuals (P for trend <0.001). Conclusion: Our results show that abdominal obesity (measured by waist circumference) and HTN had both independent and additive contributions to CHD risk. We also found that physical inactivity and abdominal obesity contribute to elevated BP in primary prevention settings.Journal of Hypertension 08/2014; 32(11). DOI:10.1097/HJH.0000000000000307 · 4.22 Impact Factor