on January 27, 2003
Circulation. 2003
Published online before print January 27, 2003, doi: 10.1161/01.CIR.0000055014.62083.05
Published online before print January 27, 2003, doi: 10.1161/01.CIR.0000055014.62083.05
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© American Heart Association, Inc.
Clinical Investigation and Reports |
C-Reactive Protein, the Metabolic Syndrome, and Risk of Incident Cardiovascular Events
An 8-Year Follow-Up of 14 719 Initially Healthy American Women
From the Center for Cardiovascular Disease Prevention (P.M.R., J.E.B., N.R.C., N.R.), the Divisions of Preventive Medicine (P.M.R., J.E.B., N.R.C.) and Cardiology (P.M.R.), and the LeDucq Center for Cardiovascular Research (P.M.R., N.R.), Brigham and Women’s Hospital, and the Department of Laboratory Medicine, Children’s Hospital (N.R.), Harvard Medical School, Boston, Mass.
Correspondence to Paul M Ridker, MD, Center for Cardiovascular Disease Prevention, 900 Commonwealth Ave E, Boston, MA 02215. E-mail pridker{at}partners.org
Background— The metabolic syndrome describes a high-risk population having 3 or more of the following clinical characteristics: upper-body obesity, hypertriglyceridemia, low HDL, hypertension, and abnormal glucose. All of these attributes, however, are associated with increased levels of C-reactive protein (CRP).
Methods and Results— We evaluated interrelationships between CRP, the metabolic syndrome, and incident cardiovascular events among 14 719 apparently healthy women who were followed up for an 8-year period for myocardial infarction, stroke, coronary revascularization, or cardiovascular death; 24% of the cohort had the metabolic syndrome at study entry. At baseline, median CRP levels for those with 0, 1, 2, 3, 4, or 5 characteristics of the metabolic syndrome were 0.68, 1.09, 1.93, 3.01, 3.88, and 5.75 mg/L, respectively (Ptrend <0.0001). Over the 8-year follow-up, cardiovascular event-free survival rates based on CRP levels above or below 3.0 mg/L were similar to survival rates based on having 3 or more characteristics of the metabolic syndrome. At all levels of severity of the metabolic syndrome, however, CRP added prognostic information on subsequent risk. For example, among those with the metabolic syndrome at study entry, age-adjusted incidence rates of future cardiovascular events were 3.4 and 5.9 per 1000 person-years of exposure for those with baseline CRP levels less than or greater than 3.0 mg/L, respectively. Additive effects for CRP were also observed for those with 4 or 5 characteristics of the metabolic syndrome. The use of different definitions of the metabolic syndrome had minimal impact on these findings.
Conclusions— These prospective data suggest that measurement of CRP adds clinically important prognostic information to the metabolic syndrome.
Key Words: protein, C-reactive • risk factors • prognosis • diabetes mellitus • inflammation
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