Laaksonen, D. E. et al. C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study. Eur. Heart J. 26, 1783-1789

Department of Medicine, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland.
European Heart Journal (Impact Factor: 15.2). 09/2005; 26(17):1783-9. DOI: 10.1093/eurheartj/ehi237
Source: PubMed


Cut-offs for C-reactive protein concentrations have been recommended for risk stratification, but little is known about how these cut-offs predict cardiovascular risk in population-based cohorts. We therefore assessed the association of C-reactive protein levels with cardiovascular mortality in a population-based cohort of 2321 middle-aged men stratified by the presence of cardiovascular disease (CVD) at baseline.
C-reactive protein concentrations were categorized according to current recommendations (1 and 3 mg/L). During the 15 year follow-up, 77 men without CVD and 121 men with CVD at baseline died of CVD. In men without CVD at baseline (n=1476), age-adjusted cardiovascular mortality was 4.1-fold higher (95% CI 2.1-8.2) for C-reactive protein levels between 3.0 and 9.9 mg/L at baseline than for C-reactive protein levels <1.0 mg/L. In men with CVD at baseline (n=845), the corresponding age-adjusted cardiovascular mortality was 3.3-fold higher (95% CI 2.0-5.3). Adjustment for conventional CVD risk factors attenuated the risk somewhat. Further adjustment for dietary and lifestyle factors and factors related to insulin resistance did not affect the association. Classification of C-reactive protein by tertiles gave qualitatively similar results, but identified twice as many men at high risk. C-reactive protein levels also predicted overall mortality.
Currently, recommended cut-offs for C-reactive protein levels identify men at risk for cardiovascular and overall death independently of conventional and other risk factors in a population-based sample of middle-aged men with and without CVD at baseline. Lower cut-offs may better identify men at high risk for cardiovascular death, but improvement of current recommendations will require standardization of C-reactive protein assays.

10 Reads
  • Source
    • "Ridker et al. proved that elevated CRP in apparently healthy men predicts the future risk of symptomatic PAD development [12]. Several studies indicate that increased hs-CRP concentration in healthy people increases the risk of cardiovascular events and overall mortality rate by 1.5–2% [13]. According to the American Heart Association, hs-CRP concentrations are currently used in clinical practice to classify mild (<1 mg/l), moderate (1–3 mg/l), and severe (>3 mg/l) risk of cardiovascular events [14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this prospective study we evaluated the effects of treadmill training on patients' walking ability, as well as endothelial function, high-sensitivity C-reactive protein (hs-CRP), and fibrinogen concentration. A total of 67 patients with stable intermittent claudication were included in a 12-week supervised training program. An observational follow-up period then lasted a mean of 37 weeks. Forty patients completed follow-up. Changes in blood pressure, flow-mediated dilatation (FMD), and treadmill walking performance expressed as maximal walking time (MWT) were assessed before and after the training program and during the follow-up period. Moreover, ankle/brachial index (ABI), plasma levels of hs-CRP, fibrinogen, as well as a lipid profile were assessed before and after the training program. Maximal walking time improved significantly after treadmill training by 90% (p<0.001) and after follow-up by 64% (p<0.001) in comparison to baseline. FMD values increased by 43% (p<0.001) after the training program, and by 29% (p=0.058) after follow-up, compared to baseline. We noticed a significant decrease in hs-CRP concentration (p=0.025) and an increase in ABI values (p=0.039) in response to the treadmill training program. No effect on lipid profile was observed. The 12-week treadmill training program prolonged the asymptomatic walking distance. The improvement in FMD indicates a systemic effect of the treadmill program on endothelial function. The supervised treadmill training provides an effective and safe treatment option in patients with PAD. The effects of unsupervised exercise during follow-up period after treadmill programs remain tentative and underestimated.
    Journal of Cardiology 01/2014; 64(2). DOI:10.1016/j.jjcc.2013.12.002 · 2.78 Impact Factor
  • Source
    • "However, there is ongoing debate on the potential of plasma CRP to predict future coronary risk over and above that of established CAD risk factors. The existing reports are contradictory [6, 12, 24–35]. Significant race-based differences in CRP levels have been reported. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Inflammation plays a pivotal role in all stages of atherosclerosis. Numerous inflammatory, lipid, and cytokines markers have been associated with coronary artery disease (CAD) risk but data directly comparing their predictive value are limited. Studies were carried to elucidate the role of high-sensitivity C-reactive protein (hsCRP), other inflammatory as well as lipid markers and their associations. Among 1021 subjects, comprising 774 CAD affected members from Indian Atherosclerosis Research Study (IARS), plasma hsCRP levels showed strong correlation with inflammatory markers, namely, IL6 (r = .373; P = <.0001), sPLA2 (r = .544; P = <.0001) as also with fibrinogen (r = .579; P = <.0001). Levels of hsCRP were higher among subjects affected by CAD who suffered a repeat coronary event as compared to those who remained event free and subjects in the top quartile of hsCRP (>3.58 mg/L) were found to have a fourfold higher risk. In conclusion, hsCRP appears to be an independent predictor of recurrent CAD events in Asian Indian population.
    International journal of vascular medicine 06/2010; 2010(2090-2824):389235. DOI:10.1155/2010/389235
  • Source
    • "Obesity is an inflammatory condition which may lead to chronic activation of the innate immune system, which in turn could cause a progressive impairment of glucose tolerance and lead to diabetes or CVD [9] [10]. In agreement with this hypothesis increased levels of high-sensitivity C-reactive protein (hs-CRP), an acute-phase protein, has shown to predict coronary heart disease (CHD) [11] [12] [13] and the development of the MetS [14], type-2 diabetes [15], and the development of both CVD and type-2 diabetes [16] [17]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This Finnish population-based study, mean age 46 years, evaluates the association of high-sensitivity C-reactive protein (hs-CRP), interleukin-1 receptor antagonist (IL-1Ra), and adiponectin with the NCEP and IDF definitions of metabolic syndrome (MetS). Adiponectin levels were higher, hs-CRP and IL-1Ra levels lower in subjects without MetS compared to subjects with MetS. If MetS was present according to both IDF and NCEP criteria, BMI, waist, triglycerides, hs-CRP, and IL-1Ra were significantly higher compared to subjects who had MetS according to either only IDF or only NCEP criteria. The hs-CRP, IL-1Ra, and adiponectin linearly correlated with the number of the components of MetS according to both definitions. Decreased levels of adiponectin and increased levels of hs-CRP and IL-1Ra are tightly associated with the components of MetS. Individuals who had MetS according to both criteria had the most adverse changes in cardiovascular risk factors.
    Mediators of Inflammation 02/2007; 2007:93573. DOI:10.1155/2007/93573 · 3.24 Impact Factor
Show more

Similar Publications