C-reactive protein and the 10-year incidence of coronary heart disease in older men and women: the cardiovascular health study.
BACKGROUND
High C-reactive protein (CRP) is associated with increased coronary heart disease risk. Few long-term data in the elderly are available.


RESULTS
Baseline CRP was measured in 3971 men and women > or =65 years of age without prior vascular diseases; 26% had elevated concentrations (>3 mg/L). With 10 years of follow-up, 547 participants developed coronary heart disease (CHD; defined as myocardial infarction or coronary death). With elevated CRP, the 10-year cumulative CHD incidences were 33% in men and 17% in women. The age-, ethnicity-, and sex-adjusted relative risk of CHD for CRP >3 mg/L compared with <1 mg/L was 1.82 (95% CI, 1.46 to 2.28). Adjusting for conventional risk factors reduced the relative risk to 1.45 (95% CI, 1.14 to 1.86). The population-attributable risk of CHD for elevated CRP was 11%. Risk relationships did not differ in subgroups defined by baseline risk factors. We assessed whether CRP improved prediction by the Framingham Risk Score. Among men with a 10-year Framingham-predicted risk of 10% to 20%, the observed CHD incidence was 32% for elevated CRP. Among women, CRP discriminated best among those with a 10-year predicted risk >20%; the incidences were 31% and 10% for elevated and normal CRP levels, respectively.


CONCLUSIONS
In older men and women, elevated CRP was associated with increased 10-year risk of CHD, regardless of the presence or absence of cardiac risk factors. A single CRP measurement provided information beyond conventional risk assessment, especially in intermediate-Framingham-risk men and high-Framingham-risk women.
Department of Medicine, University of Vermont, Burlington, VT, USA. mary.cushman@uvm.edu
Mary
M
Cushman
Alice M
AM
Arnold
Bruce M
BM
Psaty
Teri A
TA
Manolio
Lewis H
LH
Kuller
Gregory L
GL
Burke
Joseph F
JF
Polak
Russell P
RP
Tracy
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors
D015415:Biomarkers; D002097:C-Reactive Protein