C-reactive protein and prediction of coronary heart disease and global vascular events in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER).
BACKGROUND
The role of C-reactive protein (CRP) in predicting vascular events and response to statin therapy remains uncertain. Additional large prospective studies are required.


RESULTS
Baseline CRP was related to risk over 3.2 years for primary a combined end point (definite or suspected death from coronary heart disease, nonfatal myocardial infarction, and fatal or nonfatal stroke; n=865 events) and secondary (coronary heart disease events or stroke alone) and tertiary (stroke plus transient ischemic attack) end points in the Prospective Study of Pravastatin in the Elderly at Risk (n=5804 men and women; age, 70 to 82 years). CRP levels were higher in subjects who had a subsequent primary end-point event compared with those who did not (geometric mean; 3.64 mg/L [SD, 3.08 mg/L] versus 3.01 mg/L [SD, 3.05 mg/L]; P<0.0001). CRP correlated positively with body mass index and smoking status and negatively with high-density lipoprotein cholesterol. The unadjusted hazard ratio for the primary end point was 1.48 (95% CI, 1.26 to 1.74) in a comparison of top and bottom thirds for CRP, falling to 1.36 (95% CI, 1.15 to 1.61) with adjustment for established predictors and body mass index. Similar results were obtained for other end points or when results were examined separately by history of vascular disease. However, baseline CRP added minimally to risk prediction beyond conventional predictors and did not relate to the magnitude of pravastatin benefit.


CONCLUSIONS
Elevated CRP minimally enhances cardiovascular disease prediction beyond established vascular risk factors and does not predict response to statin therapy in elderly subjects at risk. These data suggest that CRP has limited clinical value in cardiovascular disease risk stratification or predicting response to statin therapy in elderly people.
Sattar
Naveed
N
Department of Vascular Biochemistry, University of Glasgow, Glasgow, Scotland, UK. nsattar@clinmed.gla.ac.uk
Murray
Heather M
HM
McConnachie
Alex
A
Blauw
Gerard J
GJ
Bollen
Edward L E M
EL
Buckley
Brendan M
BM
Cobbe
Stuart M
SM
Ford
Ian
I
Gaw
Allan
A
Hyland
Michael
M
Jukema
J Wouter
JW
Kamper
Adriaan M
AM
Macfarlane
Peter W
PW
Murphy
Michael B
MB
Packard
Chris J
CJ
Perry
Ivan J
IJ
Stott
David J
DJ
Sweeney
Brian J
BJ
Twomey
Cillian
C
Westendorp
Rudi G J
RG
Shepherd
James
J
D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000209:etiology*; D003327:Coronary Disease / Q000209:etiology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D017035:Pravastatin / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein; D017035:Pravastatin