From the Divisions of Preventive Medicine (P.M.R., R.J.G., C.H.H.) and
Cardiovascular Diseases (P.M.R.), Department of Medicine, Brigham and
Women's Hospital, and the Department of Ambulatory Care and Prevention
(C.H.H.), Harvard Medical School, Boston, Mass.
Correspondence to Dr Paul Ridker, Brigham and Women's Hospital, 900 Commonwealth Ave East, Boston, MA 02215. E-mail pmridker{at}bics.bwh.harvard.edu
Background—C-reactive protein (CRP)
is a sensitive marker of inflammation, and elevated levels have been
associated with future risk of myocardial infarction (MI). However,
whether measurement of CRP adds to the predictive value of total
cholesterol (TC) and HDL cholesterol (HDL-C) in
determining risk is uncertain.
Methods and Results—Among 14 916 apparently healthy men
participating in the Physicians' Health Study, baseline levels of CRP,
TC, and HDL-C were measured among 245 study subjects who subsequently
developed a first MI (cases) and among 372 subjects who remained free
of cardiovascular disease during an average follow-up
period of 9 years (controls). In univariate
analyses, high baseline levels of CRP, TC, and TC:HDL-C ratio
were each associated with significantly increased risks of future MI
(all P values <0.001). In multivariate
analyses, models incorporating CRP and lipid
parameters provided a significantly better method to
predict risk than did models using lipids alone (all likelihood ratio
test P values <0.003). For example, relative risks of
future MI among those with high levels of both CRP and TC (RR=5.0,
P=0.0001) were greater than the product of the
individual risks associated with isolated elevations of either CRP
(RR=1.5) or TC (RR=2.3). In stratified analyses, baseline CRP
level was predictive of risk for those with low as well as high levels
of TC and the TC:HDL-C ratio. These findings were virtually identical
in analyses limited to nonsmokers and after control for other
cardiovascular risk factors.
Conclusions—In prospective data from a large cohort of apparently
healthy men, baseline CRP level added to the predictive value of lipid
parameters in determining risk of first MI.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
C-Reactive Protein Adds to the Predictive Value of Total and HDL Cholesterol in Determining Risk of First Myocardial Infarction
Key Words: myocardial infarction • epidemiology • C-reactive protein • risk factors • cholesterol
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