This Article Full Text Full Text (PDF) All Versions of this Article: 112/9/1289    most recent CIRCULATIONAHA.104.489260v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions patientINFORMation Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Best, L. G. Articles by Howard, B. V. Search for Related Content PubMed PubMed Citation Articles by Best, L. G. Articles by Howard, B. V. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Diabetes Related Collections Risk Factors Other diagnostic testing Epidemiology Related Article

(Circulation. 2005;112:1289-1295.)
© 2005 American Heart Association, Inc.

Epidemiology

C-Reactive Protein as a Predictor of Cardiovascular Risk in a Population With a High Prevalence of Diabetes

The Strong Heart Study

Lyle G. Best, MD; Ying Zhang, PhD; Elisa T. Lee, PhD; Jeun-Liang Yeh, PhD; Linda Cowan, PhD; Vittorio Palmieri, MD; Mary Roman, MD; Richard B. Devereux, MD; Richard R. Fabsitz, PhD; Russell P. Tracy, PhD; David Robbins, MD; Michael Davidson, MD; Aftab Ahmed, MD; Barbara V. Howard, PhD

From Missouri Breaks Industries Research Inc, Timber Lake, SD (L.G.B.); University of Oklahoma Health Sciences Center, Oklahoma City (Y.Z., E.T.L., J.-L.Y., L.C.); Cornell Medical Center, New York, NY (V.P., M.R., R.B.D.); National Heart Lung and Blood Institute, Bethesda, Md (R.R.F.); Laboratory for Clinical Biochemistry Research, University of Vermont, Burlington (R.P.T.); and Medstar Research Institute, Washington, DC (D.R., M.D., A.A., B.V.H.).

Correspondence to Lyle Best, MD, #1 Airport Rd, RR1, Box 88, Rolette, ND 58366. E-mail sbest{at}utma.com

Received July 24, 2004; revision received May 23, 2005; accepted May 31, 2005.

Background— High-sensitivity C-reactive protein (CRP) has been investigated extensively as a marker for predicting the risk of cardiovascular disease (CVD). CVD accounts for a large proportion of mortality and morbidity in American Indians; we sought to test the association of CRP and CVD in a population-based American Indian cohort 45 to 74 years old.

Methods and Results— Of 3277 participants who were CVD-free at baseline, 542 had CRP >10 mg/L and were excluded from analysis; 50.1% of those included had diabetes. There were 343 CVD events among this cohort during a median follow-up of 6.2 years. Multiple CVD risk factors were used as covariates in Cox proportional-hazard models. After exclusions, the median CRP (3.2 mg/L) was higher than reported in many other populations. CRP predicted CVD in models adjusted for traditional risk factors, but not when albuminuria and fibrinogen were included. In subgroup analysis, CRP was strongly related to incident CVD among nondiabetic women participants, even after adjustment for traditional CVD risk factors and other indicators of inflammation. Conversely, CRP was elevated beyond the useful range of the American Heart Association/Centers for Disease Control and Prevention clinical guidelines in 16% of this population, and CRP was not predictive of CVD in important subgroups, such as those with diabetes.

Conclusions— CRP was a predictor of CVD in this American Indian population with a high prevalence of diabetes and other risk factors. The predictive ability of CRP varies considerably among subgroups with different risk factor profiles.

Key Words: inflammation • epidemiology • risk factors • cardiovascular diseases • diabetes mellitus

Find additional patient-related information at:

Inflammation Increases Chances of Heart Disease in People With Diabetes

Related Article:

Issue Highlights
Circulation 2005 112: 1241. [Extract] [Full Text]

This article has been cited by other articles:

				L. Lund Haheim, P. Nafstad, I. Olsen, P. Schwarze, and K. S. Ronningen C-reactive protein variations for different chronic somatic disorders Scand J Public Health, August 1, 2009; 37(6): 640 - 646. [Abstract] [PDF]

				T. Shemesh, K. G. Rowley, A. J. Jenkins, J. D. Best, and K. O'Dea C-Reactive Protein Concentrations Are Very High and More Stable over Time Than the Traditional Vascular Risk Factors Total Cholesterol and Systolic Blood Pressure in an Australian Aboriginal Cohort Clin. Chem., February 1, 2009; 55(2): 336 - 341. [Abstract] [Full Text] [PDF]

				P. M Ridker C-Reactive Protein: Eighty Years from Discovery to Emergence as a Major Risk Marker for Cardiovascular Disease Clin. Chem., February 1, 2009; 55(2): 209 - 215. [Full Text] [PDF]

				R. L. Pande, T. S. Perlstein, J. A. Beckman, and M. A. Creager Association of Insulin Resistance and Inflammation With Peripheral Arterial Disease: The National Health and Nutrition Examination Survey, 1999 to 2004 Circulation, July 1, 2008; 118(1): 33 - 41. [Abstract] [Full Text] [PDF]

				R. Clarke, J. R. Emberson, E. Breeze, J. P. Casas, S. Parish, A. D. Hingorani, A. Fletcher, R. Collins, and L. Smeeth Biomarkers of inflammation predict both vascular and non-vascular mortality in older men Eur. Heart J., March 2, 2008; 29(6): 800 - 809. [Abstract] [Full Text] [PDF]

				M. L. Fernandez and D. Webb The LDL to HDL Cholesterol Ratio as a Valuable Tool to Evaluate Coronary Heart Disease Risk J. Am. Coll. Nutr., February 1, 2008; 27(1): 1 - 5. [Abstract] [Full Text] [PDF]

				M. Gurven, H. Kaplan, J. Winking, C. Finch, and E. M. Crimmins Aging and Inflammation in Two Epidemiological Worlds J. Gerontol. A Biol. Sci. Med. Sci., February 1, 2008; 63(2): 196 - 199. [Abstract] [Full Text] [PDF]

				S. Cicala, G. de Simone, M. J. Roman, L. G. Best, E. T. Lee, W. Wang, T. K. Welty, J. M. Galloway, B. V. Howard, and R. B. Devereux Prevalence and Prognostic Significance of Wall-Motion Abnormalities in Adults Without Clinically Recognized Cardiovascular Disease: The Strong Heart Study Circulation, July 10, 2007; 116(2): 143 - 150. [Abstract] [Full Text] [PDF]

				P. M. Ridker C-Reactive Protein and the Prediction of Cardiovascular Events Among Those at Intermediate Risk: Moving an Inflammatory Hypothesis Toward Consensus J. Am. Coll. Cardiol., May 29, 2007; 49(21): 2129 - 2138. [Abstract] [Full Text] [PDF]

				T. J. Wang, P. Gona, M. G. Larson, G. H. Tofler, D. Levy, C. Newton-Cheh, P. F. Jacques, N. Rifai, J. Selhub, S. J. Robins, et al. Multiple Biomarkers for the Prediction of First Major Cardiovascular Events and Death N. Engl. J. Med., December 21, 2006; 355(25): 2631 - 2639. [Abstract] [Full Text] [PDF]

				R. B. Goldberg, J. R. Guyton, T. Mazzone, R. S. Weinstock, A. Polis, P. Edwards, J. E. Tomassini, and A. M. Tershakovec Ezetimibe/Simvastatin vs Atorvastatin in Patients With Type 2 Diabetes Mellitus and Hypercholesterolemia: The VYTAL Study Mayo Clin. Proc., December 1, 2006; 81(12): 1579 - 1588. [Abstract] [Full Text] [PDF]

				P. Libby and P. M. Ridker Inflammation and Atherothrombosis: From Population Biology and Bench Research to Clinical Practice J. Am. Coll. Cardiol., October 27, 2006; 48(9_Suppl_A): A33 - A46. [Abstract] [Full Text] [PDF]