title: Discordant association of C-reactive protein with clinical events and coronary luminal narrowing in postmenopausal women: data from the Women's Angiographic Vitamin and Estrogen (WAVE) study.
abstract: BACKGROUND
  The incidence of cardiovascular events had been shown to be associated with C-reactive protein (CRP). However, it is unclear that the cardiovascular risk associated with CRP is due to progressive coronary narrowing or to other factors such as formation of unstable plaque. This study was designed to determine the effect of baseline CRP on cardiovascular events and on the progression of atherosclerotic narrowing among 423 postmenopausal women with angiographic stenosis between 15% and 75%.
  
  
  OBJECTIVE
  Baseline CRP levels may affect cardiovascular events and progression of atherosclerotic coronary artery narrowing among postmenopausal women.
  
  
  METHODS
  Baseline and follow-up (2.8 years) angiographic data were analyzed among 320 women. Women were stratified into 4 quartiles according to baseline CRP levels. The changes in lumen diameter and clinical events in each quartile were compared.
  
  
  RESULTS
  The annualized changes in minimal and average lumen diameter in diseased and nondiseased coronary segments were not significantly associated with baseline CRP levels. The composite end point of all-cause mortality and myocardial infarction (MI) increased from 3% (3/107) in the first CRP quartile to 14% (14/98) in fourth CRP quartile (P < 0.001). Similar results were found for cardiovascular death and MI (increased from 1% (2/107) in the first quartile to 11% (11/98) in fourth quartile). The difference remained significant even after adjustment for baseline differences and cardiovascular risk factors.
  
  
  CONCLUSIONS
  Higher baseline CRP was associated with increased risk of clinical events but was not associated with annualized change in luminal diameters. Thus, increased risk of adverse events among patients with higher baseline CRP events was independent of progression of atherosclerosis as measured by change in minimal or average luminal diameter.
authors.affiliation: Department of Internal Medicine, Washington Hospital Center, Washington, DC; Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia.
authors.forename: Dhavalkumar
authors.initials: D
authors.lastname: Patel
authors.forename: Sunny
authors.initials: S
authors.lastname: Jhamnani
authors.forename: Soha
authors.initials: S
authors.lastname: Ahmad
authors.forename: Angela
authors.initials: A
authors.lastname: Silverman
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy; D018450:Disease Progression; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause / Q000097:blood*; D011379:Prognosis; D012189:Retrospective Studies; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D004967:Estrogens; D014815:Vitamins; D002097:C-Reactive Protein