title: C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease.
abstract: BACKGROUND
  C-reactive protein is an inflammatory marker believed to be of value in the prediction of coronary events. We report data from a large study of C-reactive protein and other circulating inflammatory markers, as well as updated meta-analyses, to evaluate their relevance to the prediction of coronary heart disease.
  
  
  METHODS
  Measurements were made in samples obtained at base line from up to 2459 patients who had a nonfatal myocardial infarction or died of coronary heart disease during the study and from up to 3969 controls without a coronary heart disease event in the Reykjavik prospective study of 18,569 participants. Measurements were made in paired samples obtained an average of 12 years apart from 379 of these participants in order to quantify within-person fluctuations in inflammatory marker levels.
  
  
  RESULTS
  The long-term stability of C-reactive protein values (within-person correlation coefficient, 0.59; 95 percent confidence interval, 0.52 to 0.66) was similar to that of both blood pressure and total serum cholesterol. After adjustment for base-line values for established risk factors, the odds ratio for coronary heart disease was 1.45 (95 percent confidence interval, 1.25 to 1.68) in a comparison of participants in the top third of the group with respect to base-line C-reactive protein values with those in the bottom third, and similar overall findings were observed in an updated meta-analysis involving a total of 7068 patients with coronary heart disease. By comparison, the odds ratios in the Reykjavik Study for coronary heart disease were somewhat weaker for the erythrocyte sedimentation rate (1.30; 95 percent confidence interval, 1.13 to 1.51) and the von Willebrand factor concentration (1.11; 95 percent confidence interval, 0.97 to 1.27) but generally stronger for established risk factors, such as an increased total cholesterol concentration (2.35; 95 percent confidence interval, 2.03 to 2.74) and cigarette smoking (1.87; 95 percent confidence interval, 1.62 to 2.16).
  
  
  CONCLUSIONS
  C-reactive protein is a relatively moderate predictor of coronary heart disease. Recommendations regarding its use in predicting the likelihood of coronary heart disease may need to be reviewed.
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Danesh
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Wheeler
authors.forename: Gideon M
authors.initials: GM
authors.lastname: Hirschfield
authors.forename: Shinichi
authors.initials: S
authors.lastname: Eda
authors.forename: Gudny
authors.initials: G
authors.lastname: Eiriksdottir
authors.forename: Ann
authors.initials: A
authors.lastname: Rumley
authors.forename: Gordon D O
authors.initials: GD
authors.lastname: Lowe
authors.forename: Mark B
authors.initials: MB
authors.lastname: Pepys
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D003327:Coronary Disease / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D015415:Biomarkers; D014841:von Willebrand Factor; D002097:C-Reactive Protein