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.
BACKGROUND
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.


RESULTS
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.


CONCLUSIONS
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.
Boekholdt
S Matthijs
SM
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Hack
C Erik
CE
Sandhu
Manjinder S
MS
Luben
Robert
R
Bingham
Sheila A
SA
Wareham
Nicholas J
NJ
Peters
Ron J G
RJ
Jukema
J Wouter
JW
Day
Nicholas E
NE
Kastelein
John J P
JJ
Khaw
Kay-Tee
KT
D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D006113:United Kingdom / Q000453:epidemiology
D002097:C-Reactive Protein