(Circulation. 1999;99:237-242.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
C-Reactive Protein, a Sensitive Marker of Inflammation, Predicts Future Risk of Coronary Heart Disease in Initially Healthy Middle-Aged Men
Results From the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992
From the Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany (W.K., M.F., H.-G.F.); GSF, National Research Center for Environment and Health, MEDIS Institute (M.S.) and Institute of Epidemiology (H.L., A.D.), Neuherberg, Germany; and Immunological Medicine Unit, Imperial College School of Medicine, Hammersmith Hospital, London, UK (W.L.H., M.B.P.).
Correspondence to Wolfgang Koenig, MD, Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Robert-Koch Str 8, D-89081 Ulm, Germany. E-mail wolfgang.koenig{at}medizin.uni-ulm.de
Background—Inflammatory reactions in coronary plaques play an important role in the pathogenesis of acute atherothrombotic events; inflammation elsewhere is also associated with both atherogenesis generally and its thrombotic complications. Recent studies indicate that systemic markers of inflammation can identify subjects at high risk of coronary events.
Methods and Results—We used a sensitive immunoradiometric assay to examine the association of serum C-reactive protein (CRP) with the incidence of first major coronary heart disease (CHD) event in 936 men 45 to 64 years of age. The subjects, who were sampled at random from the general population, participated in the first MONICA Augsburg survey (1984 to 1985) and were followed for 8 years. There was a positive and statistically significant unadjusted relationship, which was linear on the log-hazards scale, between CRP values and the incidence of CHD events (n=53). The hazard rate ratio (HRR) of CHD events associated with a 1-SD increase in log-CRP level was 1.67 (95% CI, 1.29 to 2.17). After adjustment for age, the HRR was 1.60 (95% CI, 1.23 to 2.08). Adjusting further for smoking behavior, the only variable selected from a variety of potential confounders by a forward stepping process with a 5% change in the relative risk of CRP as the selection criterion, yielded an HRR of 1.50 (95% CI, 1.14 to 1.97).
Conclusions—These results confirm the prognostic relevance of CRP, a sensitive systemic marker of inflammation, to the risk of CHD in a large, randomly selected cohort of initially healthy middle-aged men. They suggest that low-grade inflammation is involved in pathogenesis of atherosclerosis, especially its thrombo-occlusive complications.
Key Words: proteins • coronary disease • incidence • epidemiology
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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]
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C. Kasapis and P. D. Thompson The Effects of Physical Activity on Serum C-Reactive Protein and Inflammatory Markers: A Systematic Review J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1563 - 1569. [Abstract] [Full Text] [PDF]
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J.P. Empana, D.H. Sykes, G. Luc, I. Juhan-Vague, D. Arveiler, J. Ferrieres, P. Amouyel, A. Bingham, M. Montaye, J.B. Ruidavets, et al. Contributions of Depressive Mood and Circulating Inflammatory Markers to Coronary Heart Disease in Healthy European Men: The Prospective Epidemiological Study of Myocardial Infarction (PRIME) Circulation, May 10, 2005; 111(18): 2299 - 2305. [Abstract] [Full Text] [PDF]
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M. Schillinger, M. Exner, W. Mlekusch, S. Sabeti, J. Amighi, R. Nikowitsch, E. Timmel, B. Kickinger, C. Minar, M. Pones, et al. Inflammation and Carotid Artery--Risk for Atherosclerosis Study (ICARAS) Circulation, May 3, 2005; 111(17): 2203 - 2209. [Abstract] [Full Text] [PDF]
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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]
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H.-K. Yip, C.-L. Hang, C.-Y. Fang, Y.-K. Hsieh, C.-H. Yang, W.-C. Hung, and C.-J. Wu Level of High-Sensitivity C-Reactive Protein Is Predictive of 30-Day Outcomes in Patients With Acute Myocardial Infarction Undergoing Primary Coronary Intervention Chest, March 1, 2005; 127(3): 803 - 808. [Abstract] [Full Text] [PDF]
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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]
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M. Gola, S. Bonadonna, M. Doga, and A. Giustina Growth Hormone and Cardiovascular Risk Factors J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1864 - 1870. [Abstract] [Full Text] [PDF]
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R. Schnabel, H. J. Rupprecht, K. J. Lackner, E. Lubos, C. Bickel, J. Meyer, T. Munzel, F. Cambien, L. Tiret, S. Blankenberg, et al. Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study Eur. Heart J., February 1, 2005; 26(3): 241 - 249. [Abstract] [Full Text] [PDF]
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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]
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G. K. Paschos, N. Yiannakouris, L. S. Rallidis, I. Davies, B. A. Griffin, D. B. Panagiotakos, F. N. Skopouli, V. Votteas, and A. Zampelas Apolipoprotein E Genotype in Dyslipidemic Patients and Response of Blood Lipids and Inflammatory Markers to Alpha-Linolenic Acid Angiology, January 1, 2005; 56(1): 49 - 60. [Abstract] [PDF]
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A. Ropponen, K. Aittomaki, M. J. Tikkanen, and O. Ylikorkala Levels of Serum C-Reactive Protein during Oral and Transdermal Estradiol in Postmenopausal Women with and without a History of Intrahepatic Cholestasis of Pregnancy J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 142 - 146. [Abstract] [Full Text] [PDF]
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G. L. Myers, N. Rifai, R. P. Tracy, W. L. Roberts, R. W. Alexander, L. M. Biasucci, J. D. Catravas, T. G. Cole, G. R. Cooper, B. V. Khan, et al. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Report From the Laboratory Science Discussion Group Circulation, December 21, 2004; 110(25): e545 - e549. [Full Text] [PDF]
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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]
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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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