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on March 15, 2004

Circulation. 2004
Published online before print March 15, 2004, doi: 10.1161/01.CIR.0000120707.98922.E3
A more recent version of this article appeared on March 23, 2004
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Submitted on April 25, 2003
Revised on December 17, 2003
Accepted on December 29, 2003

C-Reactive Protein Modulates Risk Prediction Based on the Framingham Score. Implications for Future Risk Assessment: Results From a Large Cohort Study in Southern Germany

Wolfgang Koenig MD*, Hannelore Löwel MD, Jens Baumert MS, and Christa Meisinger MD, MPH

From the Department of Internal Medicine II, Cardiology, University of Ulm Medical Center, Ulm, Germany (W.K.); GSF, National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany (H.L., J.B., C.M.); and MONICA/KORA Coronary Event Register, Central Hospital, Augsburg, Germany (H.L., C.M.).

* To whom correspondence should be addressed. E-mail: wolfgang.koenig{at}medizin.uni-ulm.de.

Background--The Framingham Coronary Heart Disease (CHD) prediction score is recommended for global risk assessment in subjects prone to CHD. Recently, C-reactive protein (CRP) has emerged as an independent predictor of CHD. We sought to assess the potential of CRP measurements to enhance risk prediction based on the Framingham Risk Score (FRS) in a large cohort of middle-aged men from the general population.

Methods and Results--We measured CRP and traditional cardiovascular risk factors at baseline in 3435 white men of German nationality, 45 to 74 years of age. All men were drawn from 3 random samples of the general population in the Augsburg area located in Southern Germany in 1984 to 1985, 1989 to 1990, and 1994 to 1995 (response rate, 80%), and the FRS was calculated in all of them. Outcome was defined as nonfatal and fatal coronary events, including sudden cardiac death. During an average follow-up of 6.6 years, a total of 191 coronary events occurred. Cox regression showed a significant contribution of CRP to coronary event risk prediction independent of the FRS (P=0.0002). In stratified analysis for 5 categories of FRS, CRP significantly added prognostic information to the FRS in subjects in 2 intermediate risk categories (P=0.03 and P=0.02).

Conclusions--Our results suggest that CRP enhances global coronary risk as assessed by the FRS, especially in intermediate risk groups. This might have implications for future risk assessment.


Key words: inflammation • risk factors • coronary disease • epidemiology • prevention




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