From the Divisions of Cardiology (P.M.R.) and Preventive Medicine
(P.M.R., J.E.B., C.H.H.), Brigham and Women's Hospital, and the
Department of Ambulatory Care and Prevention (J.E.B., C.H.H.), Harvard Medical
School, Boston, Mass; and Abbott Laboratories, Abbott Park, Ill (M.M., J.S.).
Correspondence to Paul M. Ridker, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail pmridker{at}bics.bwh.harvard.edu
Abstract
Background—C-reactive protein (CRP)
predicts risk of myocardial infarction (MI) and stroke among apparently
healthy men, but in women, virtually no data are available.
Methods and Results—CRP was measured in baseline blood samples
from 122 apparently healthy participants in the Women's Health Study
who subsequently suffered a first cardiovascular event
and from 244 age- and smoking-matched control subjects who remained
free of cardiovascular disease during a 3-year
follow-up period. Women who developed cardiovascular
events had higher baseline CRP levels than control subjects
(P=0.0001), such that those with the highest levels at
baseline had a 5-fold increase in risk of any vascular event (RR=4.8;
95% CI, 2.3 to 10.1; P=0.0001) and a 7-fold increase in
risk of MI or stroke (RR=7.3; 95% CI, 2.7 to 19.9;
P=0.0001). Risk estimates were independent of other risk
factors, and prediction models that included CRP provided a better
method to predict risk than models that excluded CRP (all
P values <0.01). In stratified analyses, CRP
was a predictor among subgroups of women with low as well as high risk
as defined by other cardiovascular risk factors.
Conclusions—In these prospective data among women, CRP is a
strong independent risk factor for cardiovascular
disease that adds to the predictive value of risk models based on usual
factors alone.
C-reactive protein
(CRP) is a marker for inflammation that appears to predict
cardiovascular events among apparently healthy men. For
example, in the prospective Physicians' Health Study (PHS), high
plasma concentration of CRP was associated with a 2-fold
increase in risk of stroke, a 3-fold increase in risk of myocardial
infarction (MI), and a 4-fold increase in risk of developing
peripheral vascular disease.1 2
Moreover, CRP adds to the predictive value of total and HDL
cholesterol such that the risk of future MI for men with
elevated levels of CRP and hyperlipidemia appears to be
greater than the product of the risks associated with either
abnormality alone.3 Finally, CRP has been
associated with increased risks of fatal coronary events among
high-risk male smokers,4 incident
coronary disease among the elderly,5 and
recurrent coronary events among those with known
coronary disease.6 7 8
In women, prospective data evaluating CRP are sparse. We therefore
sought to determine whether CRP was also an independent predictor of
future vascular disease among currently healthy women.
Methods
The study population consisted of participants in the Women's
Health Study (WHS), a primary prevention trial being conducted among
39 876 postmenopausal female health professionals with no prior
history of MI, stroke, or transient ischemic
attack.9 Among these women, 28 263 (70.9%)
provided baseline blood samples collected in EDTA, which, after cold
overnight shipping, were centrifuged and frozen at -170°C
until analysis.
Questionnaires are sent to WHS participants to elicit information on
risk factors and incident health events. For all cases of MI, stroke,
PTCA, CABG, or cardiovascular death reported after
enrollment, hospital records are obtained and reviewed. Reported MI
was confirmed if symptoms met World Health Organization criteria and
the event was associated with elevated cardiac enzymes or
characteristic ECG changes. Reported stroke was confirmed if the
patient had a new neurological deficit with signs and symptoms
persisting for >24 hours; CT scans were available in most cases.
Reported revascularization procedures were
confirmed by hospital records. Coronary deaths were
confirmed by autopsy reports, death certificates, and circumstances of
death.
For each case subject who provided a baseline blood sample, 2 control
subjects of the same age (±1 year) and smoking pattern (current, past,
never) who also provided a baseline plasma sample and who remained free
of reported vascular disease during follow-up were selected; 122 women
who suffered a first cardiovascular event during a
36-month follow-up period and 244 who remained free of disease were
included in this analysis. Plasma samples for each subject were
thawed and assayed for CRP with a high-sensitivity ELISA (Abbott
Laboratories).10
We used Student's t test to evaluate differences in means
and the
Results
Baseline characteristics of study participants are shown in Table 1
Case subjects had higher median CRP levels at baseline than control
subjects (P=0.0001). In age- and smoking-matched
analyses, the risk of future vascular events increased with
each increasing quartile of CRP (P for trend=0.0001) such
that women with the highest levels had a 5-fold increase in risk of any
vascular event (RR=4.8; 95% CI, 2.3 to 10.1; P=0.0001) and
a 7-fold increase in risk of MI or stroke (RR=7.3; 95% CI, 2.7 to
19.9; P=0.0001); estimates were minimally altered after
control for other risk factors (Table 2
To evaluate whether CRP adds to usual risk factors in predicting future
vascular events, likelihood ratio tests were used to compare the fit of
prediction models that specifically included or excluded log-normalized
CRP. In these analyses, the simultaneous assessment
of CRP and traditional risk factors provided an improved ability to
predict risk over models limited to traditional factors alone (all
P values <0.01). For example, models that used CRP in
addition to hyperlipidemia, hypertension, diabetes, a
family history of coronary disease, and body mass index
provided a significant improvement in prediction (P=0.005)
compared with models that excluded CRP.
Baseline levels of CRP predicted risk of vascular disease among women
with and without other cardiovascular risk factors.
These effects were most striking among women who appeared to be at low
baseline risk; elevated levels of CRP were associated with a 4-fold
increase in risk in analyses limited to nonsmokers (RR=4.5,
P=0.001) or to those with no history of
hyperlipidemia (RR=3.9, P=0.002). Similarly,
elevated levels of CRP were associated with increased risk among women
with no history of hypertension (RR=2.8, P=0.03), no
evidence of diabetes (RR=4.9, P=0.001), or those with no
family history of premature atherosclerosis (RR=6.6,
P=0.001) (Table 3
Discussion
These prospective data indicate that baseline CRP concentration is
an independent risk factor for cardiovascular disease
among apparently healthy middle-aged women. Moreover, in these data,
the predictive value of models that include CRP is significantly better
than those limited to usual risk factors. Finally, these data indicate
that CRP predicts vascular events even among low-risk subgroups of
women with no readily apparent markers for disease.
Previous studies of CRP in healthy populations have almost exclusively
been limited to men.1 2 3 4 As such, the present
data extend prior observations concerning the potential clinical
utility of CRP as a marker for vascular disease. Our primary prevention
data in women are also consistent with subgroup observations
from the Cardiovascular Health Study, in which CRP
levels were found to predict risk among 41 elderly women with evidence
of subclinical cardiovascular disease, as well as
observations from the Rural Health Promotion Project, in which CRP
levels were higher among 65 elderly women at risk for vascular
events.5 In both of these prior subgroup
analyses, the risks of vascular disease associated with CRP
were greater for women than for men. This also appears to be the case
for our data, in which the adjusted RR of either MI or stroke for women
with CRP levels in the highest quartile was 5.5, compared with 2.8 for
men participating in the PHS.1 Whether these
differences reflect chance or effect modification by sex requires
investigation.
It is also of interest that median levels of CRP in the present
study of women are higher overall than levels observed in previous
studies of men.1 2 3 Although this may further
reflect sex-specific effects, it is important to recognize that the CRP
assay techniques and the methods of blood collection and storage in the
present study are somewhat different from those used in previous
studies. The higher median CRP levels observed in the present data
may also reflect the fact that, at least compared with men evaluated in
the PHS,1 2 3 women in the present
analysis were more likely to be current smokers, were heavier,
and had a higher prevalence of hypertension,
hyperlipidemia, and family history of premature
atherosclerosis; all of these factors are associated
with increased CRP levels1 2 3 4 5 6 7 and thus might
contribute to a higher overall distribution of baseline values.
These data support the hypothesis that low-grade inflammation is a
marker for subsequent cardiovascular disease. Whether
CRP has direct vascular or prothrombotic effects, reflects underlying
endothelial dysfunction due to prevalent
atherosclerosis, leads to increased lipid peroxidation,
or is simply a marker resulting from an as yet undetermined
environmental and/or infectious stimulus remains to be
elucidated.11 12
Acknowledgments
This study was supported by grants from the National Institutes
of Health and by an Established Investigator Award from the American
Heart Association (Dr Ridker).
Received April 15, 1998;
revision received June 15, 1998;
accepted June 23, 1998.
References
1.
Ridker PM, Cushman M, Stampfer MJ, Tracy R,
Hennekens CH. Inflammation, aspirin, and the risk of
cardiovascular disease in apparently healthy men.
N Engl J Med. 1997;336:973–979.
2.
Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens
CH. Plasma concentration of C-reactive protein and risk of developing
peripheral vascular disease. Circulation. 1998;97:425–428.
3.
Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein
adds to the predictive value of total and HDL cholesterol
in determining risk of first myocardial infarction.
Circulation. 1998;97:2007–2011.
4.
Kuller LH, Tracy RP, Shaten J, Meilahn EN, for the
MRFIT Research Group. Relationship of C-reactive protein and
coronary heart disease in the MRFIT nested case-control study.
Am J Epidemiol. 1996;144:537–547.
5.
Tracy RP, Lemaitre RN, Psaty BM, Ives DG, Evans RW,
Cushman M, Meilahn EN, Kuller LH. Relationship of C-reactive protein to
risk of cardiovascular disease in the elderly: results
from the Cardiovascular Health Study and the Rural
Health Promotion Project. Arterioscler Thromb Vasc Biol. 1997;17:1121–1127.
6.
Liuzzo G, Biasucci LM, Gallimore JR, Grillo RL,
Rebuzzi AG, Pepys MB, Maseri A. The prognostic value of C-reactive
protein and serum amyloid A protein in severe unstable angina.
N Engl J Med. 1994;331:417–424.
7.
Thompson SG, Kienast J, Pyke SDM, Haverkate F, van de
Loo JCW, European Concerted Action on Thrombosis and Disabilities
Angina Pectoris Study Group. Hemostatic factors and the risk of
myocardial infarction or sudden death in patients with angina pectoris.
N Engl J Med. 1995;332:635–641.
8.
Ridker PM, Rifai N, Pfeffer MA, Sacks FM, Moye LA,
Goldman S, Flaker GC, Braunwald E, for the Cholesterol, and
Recurrent Events (CARE) Investigators. Inflammation,
pravastatin, and the risk of coronary events after
myocardial infarction in patients with average cholesterol
levels. Circulation. In press.
9.
Buring JE, Hennekens CH, for the Women's Health Study
Research Group. The Women's Health Study: summary of the study design.
J Myocard Ischemia. 1992;4:27–29.
10.
Wilkins J, Gallimore R, Moore EG, Pepys MB. Rapid
automated high sensitivity enzyme immunoassay of C-reactive protein.
Clin Chem. 1998;44:1358–1361.
11.
Ridker PM. Inflammation, infection, and
cardiovascular risk: how good is the clinical evidence?
Circulation. 1998;98:1671–1674.
12.
Tracy RP. Inflammation in
cardiovascular disease: cart, horse, or both?
Circulation. 1998;97:2000–2002.C-reactive
protein (CRP) was measured in 122 apparently healthy women who
subsequently suffered a first cardiovascular event and
in 244 age- and smoking-matched control subjects who remained free of
cardiovascular disease during a follow-up period of 36
months. Risks increased with increasing quartiles of CRP such that
women with the highest levels at baseline had a 5-fold increase in risk
of any vascular event (P=0.0001) and a 7-fold increase
in risk of MI or stroke (P=0.0001). Risk estimates were
independent of other risk factors, and prediction models that included
CRP provided a better method to predict risk than did models that
excluded CRP.
© 1998 American Heart Association, Inc.
Brief Rapid Communication
Prospective Study of C-Reactive Protein and the Risk of Future Cardiovascular Events Among Apparently Healthy Women
Key Words: C-reactive protein • inflammation • cardiovascular diseases
2 statistic to evaluate differences in
proportions. Because the distribution of CRP levels was skewed,
differences in medians were tested with the rank sum test. Logistic
regression was used to estimate relative risks (RRs) and 95% CIs.
Tests for trend were used to assess relationships of increasing levels
of CRP with risk after the cohort was divided into quartiles defined by
the distribution of the control subjects. Likelihood ratio tests were
used to determine whether prediction models that included CRP provided
a better fit than did models limited to traditional risk factors alone.
All P values were 2-tailed. 
. As expected, case subjects had higher
rates of usual cardiovascular risk factors than control
subjects. Because of matching, age and smoking status were virtually
identical between study groups.
View this table:
[in a new window]
Table 1. Baseline Characteristics of Study
Participants ).
View this table:
[in a new window]
Table 2. Relative Risks of Future Cardiovascular Events Among
Apparently Healthy Women According to Baseline Concentration of
CRP ).
View this table:
[in a new window]
Table 3. Relative Risks of Future Cardiovascular Events Among
Low-Risk Subgroups of Women According to Baseline Concentration of CRP
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 |
|
 K. Suzuki, Y. Ito, K. Wakai, M. Kawado, S. Hashimoto, N. Seki, M. Ando, Y. Nishino, T. Kondo, Y. Watanabe, et al. Serum heat shock protein 70 levels and lung cancer risk: a case-control study nested in a large cohort study. Cancer Epidemiol. Biomarkers Prev., September 1, 2006; 15(9): 1733 - 1737. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Bushnell, P. Hurn, C. Colton, V. M. Miller, G. del Zoppo, M. S.V. Elkind, B. Stern, D. Herrington, G. Ford-Lynch, P. Gorelick, et al. Advancing the Study of Stroke in Women: Summary and Recommendations for Future Research From an NINDS-Sponsored Multidisciplinary Working Group Stroke, September 1, 2006; 37(9): 2387 - 2399. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. F. Elias, M. A. Robbins, M. M. Budge, P. K. Elias, S. L. Brennan, C. Johnston, Z. Nagy, and C. J. Bates Homocysteine, Folate, and Vitamins B6 and B12 Blood Levels in Relation to Cognitive Performance: The Maine-Syracuse Study Psychosom Med, July 1, 2006; 68(4): 547 - 554. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Paffen and M. P.M. deMaat C-reactive protein in atherosclerosis: A causal factor? Cardiovasc Res, July 1, 2006; 71(1): 30 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ziakas, S. Gavrilidis, G. Giannoglou, E. Souliou, K. Gemitzis, D. Kalampalika, M. A. Vayona, I. Pidonia, G. Parharidis, and G. Louridas In-Hospital and Long-Term Prognostic Value of Fibrinogen, CRP, and IL-6 Levels in Patients with Acute Myocardial Infarction Treated with Thrombolysis Angiology, May 1, 2006; 57(3): 283 - 293. [Abstract] [PDF]
|
|
|
|
|
|
T. W. McDade, L. C. Hawkley, and J. T. Cacioppo Psychosocial and Behavioral Predictors of Inflammation in Middle-Aged and Older Adults: The Chicago Health, Aging, and Social Relations Study Psychosom Med, May 1, 2006; 68(3): 376 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Ma, J. A Griffith, L. Chasan-Taber, B. C Olendzki, E. Jackson, E. J Stanek III, W. Li, S. L Pagoto, A. R Hafner, and I. S Ockene Association between dietary fiber and serum C-reactive protein. Am. J. Clinical Nutrition, April 1, 2006; 83(4): 760 - 766. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. H. James, M. G. Jamison, M. S. Biswas, L. R. Brancazio, G. K. Swamy, and E. R. Myers Acute Myocardial Infarction in Pregnancy: A United States Population-Based Study Circulation, March 28, 2006; 113(12): 1564 - 1571. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. McCaffery, N. Frasure-Smith, M.-P. Dube, P. Theroux, G. A. Rouleau, Q. Duan, and F. Lesperance Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med, March 1, 2006; 68(2): 187 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Shaw, C. N. Bairey Merz, C. J. Pepine, S. E. Reis, V. Bittner, S. F. Kelsey, M. Olson, B. D. Johnson, S. Mankad, B. L. Sharaf, et al. Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender Differences in Traditional and Novel Risk Factors, Symptom Evaluation, and Gender-Optimized Diagnostic Strategies J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S4 - S20. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Newall, A. D. Grayson, A. Y. Oo, N. D. Palmer, W. C. Dihmis, A. Rashid, and R. H. Stables Preoperative White Blood Cell Count is Independently Associated With Higher Perioperative Cardiac Enzyme Release and Increased 1-Year Mortality After Coronary Artery Bypass Grafting Ann. Thorac. Surg., February 1, 2006; 81(2): 583 - 589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Wakugawa, Y. Kiyohara, Y. Tanizaki, M. Kubo, T. Ninomiya, J. Hata, Y. Doi, K. Okubo, Y. Oishi, K. Shikata, et al. C-Reactive Protein and Risk of First-Ever Ischemic and Hemorrhagic Stroke in a General Japanese Population: The Hisayama Study Stroke, January 1, 2006; 37(1): 27 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S G Baidya and Q-T Zeng Helper T cells and atherosclerosis: the cytokine web Postgrad. Med. J., December 1, 2005; 81(962): 746 - 752. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Booth, N. R. Obeid, and B. R. Lucchesi Activation of estrogen receptor-{alpha} protects the in vivo rabbit heart from ischemia-reperfusion injury Am J Physiol Heart Circ Physiol, November 1, 2005; 289(5): H2039 - H2047. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Clearfield C-Reactive Protein: A New Risk Assessment Tool for Cardiovascular Disease J Am Osteopath Assoc, September 1, 2005; 105(9): 409 - 416. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Laaksonen, L. Niskanen, K. Nyyssonen, K. Punnonen, T.-P. Tuomainen, and J. T. Salonen C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study Eur. Heart J., September 1, 2005; 26(17): 1783 - 1789. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Best, Y. Zhang, E. T. Lee, J.-L. Yeh, L. Cowan, V. Palmieri, M. Roman, R. B. Devereux, R. R. Fabsitz, R. P. Tracy, et al. C-Reactive Protein as a Predictor of Cardiovascular Risk in a Population With a High Prevalence of Diabetes: The Strong Heart Study Circulation, August 30, 2005; 112(9): 1289 - 1295. [Abstract] [Full Text] [PDF]
|
|
|
|
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|
A. Khera, D. K. McGuire, S. A. Murphy, H. G. Stanek, S. R. Das, W. Vongpatanasin, F. H. Wians Jr, S. M. Grundy, and J. A. de Lemos Race and Gender Differences in C-Reactive Protein Levels J. Am. Coll. Cardiol., August 2, 2005; 46(3): 464 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.-H. Huang, L.-C. Chen, H.-B. Leu, P. Y.-A. Ding, J.-W. Chen, T.-C. Wu, and S.-J. Lin Enhanced Coronary Calcification Determined by Electron Beam CT Is Strongly Related to Endothelial Dysfunction in Patients With Suspected Coronary Artery Disease Chest, August 1, 2005; 128(2): 810 - 815. [Abstract] [Full Text] [PDF]
|
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|
|
 |
|
 U. J. F. Tietge, D. Pratico, T. Ding, C. D. Funk, R. B. Hildebrand, T. Van Berkel, and M. Van Eck Macrophage-specific expression of group IIA sPLA2 results in accelerated atherogenesis by increasing oxidative stress J. Lipid Res., August 1, 2005; 46(8): 1604 - 1614. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Inoue, T. Kato, T. Uchida, M. Sakuma, A. Nakajima, M. Shibazaki, Y. Imoto, M. Saito, S. Hashimoto, Y. Hikichi, et al. Local Release of C-Reactive Protein From Vulnerable Plaque or Coronary Arterial Wall Injured by Stenting J. Am. Coll. Cardiol., July 19, 2005; 46(2): 239 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. B. Pepys CRP or not CRP? That Is the Question Arterioscler Thromb Vasc Biol, June 1, 2005; 25(6): 1091 - 1094. [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. King, A. G. Mainous III, B. M. Egan, R. F. Woolson, and M. E. Geesey Fiber and C-Reactive Protein in Diabetes, Hypertension, and Obesity Diabetes Care, June 1, 2005; 28(6): 1487 - 1489. [Full Text] [PDF]
|
|
|
|
|
|
C. Arnaud, F. Burger, S. Steffens, N. R. Veillard, T. H. Nguyen, D. Trono, and F. Mach Statins Reduce Interleukin-6-Induced C-Reactive Protein in Human Hepatocytes: New Evidence for Direct Antiinflammatory Effects of Statins Arterioscler Thromb Vasc Biol, June 1, 2005; 25(6): 1231 - 1236. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Zieske, R. P. Tracy, C. A. McMahan, E. E. Herderick, S. Homma, G. T. Malcom, H. C. McGill Jr, J. P. Strong, and for the Pathobiological Determinants of Atheroscle Elevated Serum C-Reactive Protein Levels and Advanced Atherosclerosis in Youth Arterioscler Thromb Vasc Biol, June 1, 2005; 25(6): 1237 - 1243. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Di Napoli, M. Schwaninger, R. Cappelli, E. Ceccarelli, G. Di Gianfilippo, C. Donati, H. C.A. Emsley, S. Forconi, S. J. Hopkins, L. Masotti, et al. Evaluation of C-Reactive Protein Measurement for Assessing the Risk and Prognosis in Ischemic Stroke: A Statement for Health Care Professionals From the CRP Pooling Project Members Stroke, June 1, 2005; 36(6): 1316 - 1329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Lo, R. Fijnheer, A. P. Nierich, P. Bruins, and C. J. Kalkman C-Reactive Protein is a Risk Indicator for Atrial Fibrillation After Myocardial Revascularization Ann. Thorac. Surg., May 1, 2005; 79(5): 1530 - 1535. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kovacs, P. Henriksson, A. Hamsten, H. Wallen, J. Bjorkegren, and P. Tornvall Hormonal Regulation of Circulating C-Reactive Protein in Men Clin. Chem., May 1, 2005; 51(5): 911 - 913. [Full Text] [PDF]
|
|
|
|
|
|
Y. Doi, Y. Kiyohara, M. Kubo, Y. Tanizaki, K. Okubo, T. Ninomiya, M. Iwase, and M. Iida Relationship Between C-Reactive Protein and Glucose Levels in Community-Dwelling Subjects Without Diabetes: The Hisayama Study Diabetes Care, May 1, 2005; 28(5): 1211 - 1213. [Full Text] [PDF]
|
|
|
|
|
|
S. B. Kritchevsky, M. Cesari, and M. Pahor Inflammatory markers and cardiovascular health in older adults Cardiovasc Res, May 1, 2005; 66(2): 265 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Q. Wang, X. Zhu, Q. Xu, X. Ding, Y. E. Chen, and Q. Song Effect of C-reactive protein on gene expression in vascular endothelial cells Am J Physiol Heart Circ Physiol, April 1, 2005; 288(4): H1539 - H1545. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Stuveling, S. J. L. Bakker, H. L. Hillege, P. E. de Jong, R. O. B. Gans, and D. de Zeeuw Biochemical risk markers: a novel area for better prediction of renal risk? Nephrol. Dial. Transplant., March 1, 2005; 20(3): 497 - 508. [Full Text] [PDF]
|
|
|
|
|
|
S. Malik, N. D. Wong, S. Franklin, J. Pio, C. Fairchild, and R. Chen Cardiovascular Disease in U.S. Patients With Metabolic Syndrome, Diabetes, and Elevated C-Reactive Protein Diabetes Care, March 1, 2005; 28(3): 690 - 693. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. RETTERSTOL, K. E. BERGE, O. BRAATEN, L. EIKVAR, T. R. PEDERSEN, and L. SANDVIK A DAILY GLASS OF RED WINE: DOES IT AFFECT MARKERS OF INFLAMMATION? Alcohol Alcohol., March 1, 2005; 40(2): 102 - 105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Lauver, E. A. Booth, A. J. White, E. Poradosu, and B. R. Lucchesi Sulodexide Attenuates Myocardial Ischemia/Reperfusion Injury and the Deposition of C-Reactive Protein in Areas of Infarction without Affecting Hemostasis J. Pharmacol. Exp. Ther., February 1, 2005; 312(2): 794 - 800. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. J. Chang and R. C. Harris Are All COX-2 Inhibitors Created Equal? Hypertension, February 1, 2005; 45(2): 178 - 180. [Full Text] [PDF]
|
|
|
|
|
|
P. Bogaty, J. M. Brophy, L. Boyer, S. Simard, L. Joseph, F. Bertrand, and G. R. Dagenais Fluctuating Inflammatory Markers in Patients With Stable Ischemic Heart Disease Arch Intern Med, January 24, 2005; 165(2): 221 - 226. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. K. Roberts and R. J. Barnard Effects of exercise and diet on chronic disease J Appl Physiol, January 1, 2005; 98(1): 3 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Smith Jr, J. L. Anderson, R. O. Cannon III, Y. Y. Fadl, W. Koenig, P. Libby, S. E. Lipshultz, G. A. Mensah, P. M Ridker, and R. Rosenson CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Report From the Clinical Practice Discussion Group Circulation, December 21, 2004; 110(25): e550 - e553. [Full Text] [PDF]
|
|
|
|
|
|
S. P. Fortmann, E. Ford, M. H. Criqui, A. R. Folsom, T. B. Harris, Y. Hong, T. A. Pearson, D. Siscovick, F. Vinicor, and P. F. Wilson CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Report From the Population Science Discussion Group Circulation, December 21, 2004; 110(25): e554 - e559. [Abstract] [Full Text] [PDF]
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L. M. Fischer, R. G. Schlienger, C. M. Matter, H. Jick, and C. R. Meier Discontinuation of Nonsteroidal Anti-inflammatory Drug Therapy and Risk of Acute Myocardial Infarction Arch Intern Med, December 13, 2004; 164(22): 2472 - 2476. [Abstract] [Full Text] [PDF]
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|
E. O. Talbott, J. V. Zborowski, M. Y. Boudreaux, K. P. McHugh-Pemu, K. Sutton-Tyrrell, and D. S. Guzick The Relationship between C-Reactive Protein and Carotid Intima-Media Wall Thickness in Middle-Aged Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., December 1, 2004; 89(12): 6061 - 6067. [Abstract] [Full Text] [PDF]
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|
|
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L. Niskanen, D. E. Laaksonen, K. Nyyssonen, K. Punnonen, V.-P. Valkonen, R. Fuentes, T.-P. Tuomainen, R. Salonen, and J. T. Salonen Inflammation, Abdominal Obesity, and Smoking as Predictors of Hypertension Hypertension, December 1, 2004; 44(6): 859 - 865. [Abstract] [Full Text] [PDF]
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|
|
 |
|
 K. Yaffe, A. Kanaya, K. Lindquist, E. M. Simonsick, T. Harris, R. I. Shorr, F. A. Tylavsky, and A. B. Newman The Metabolic Syndrome, Inflammation, and Risk of Cognitive Decline JAMA, November 10, 2004; 292(18): 2237 - 2242. [Abstract] [Full Text] [PDF]
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 |
|
 J. H. Meurman, M. Sanz, and S.-J. Janket ORAL HEALTH, ATHEROSCLEROSIS, AND CARDIOVASCULAR DISEASE Critical Reviews in Oral Biology & Medicine, November 1, 2004; 15(6): 403 - 413. [Abstract] [Full Text] [PDF]
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T. Khreiss, L. Jozsef, L. A. Potempa, and J. G. Filep Opposing Effects of C-Reactive Protein Isoforms on Shear-Induced Neutrophil-Platelet Adhesion and Neutrophil Aggregation in Whole Blood Circulation, October 26, 2004; 110(17): 2713 - 2720. [Abstract] [Full Text] [PDF]
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J.-P. Despres CRP and Risk of Coronary Heart Disease: Can Exercise Training Cool Down the Flames? Arterioscler Thromb Vasc Biol, October 1, 2004; 24(10): 1743 - 1745. [Full Text] [PDF]
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|
|
 |
|
 S Kony, M Zureik, F Driss, C Neukirch, B Leynaert, and F Neukirch Association of bronchial hyperresponsiveness and lung function with C-reactive protein (CRP): a population based study Thorax, October 1, 2004; 59(10): 892 - 896. [Abstract] [Full Text] [PDF]
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E. Zouridakis, P. Avanzas, R. Arroyo-Espliguero, S. Fredericks, and J. C. Kaski Markers of Inflammation and Rapid Coronary Artery Disease Progression in Patients With Stable Angina Pectoris Circulation, September 28, 2004; 110(13): 1747 - 1753. [Abstract] [Full Text] [PDF]
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J.-J. Li, C.-H. Fang, H. Jiang, C.-X. Hunag, Q.-Z. Tang, X.-H. Wang, and G.-S. Li Increased C-Reactive Protein Level After Renal Stent Implantation in Patients with Atherosclerotic Renal Stenosis Angiology, September 1, 2004; 55(5): 479 - 484. [Abstract] [PDF]
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