Published online before print June 27, 2005, doi: 10.1161/CIRCULATIONAHA.104.504159
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(Circulation. 2005;112:25-31.)
© 2005 American Heart Association, Inc.
Coronary Heart Disease |
C-Reactive Protein and the 10-Year Incidence of Coronary Heart Disease in Older Men and Women
The Cardiovascular Health Study
From the Departments of Medicine and Pathology (M.C.) and Pathology and Biochemistry (R.P.T.), University of Vermont, Burlington; Departments of Biostatistics (A.M.A.) and Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (L.H.K.); Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (G.L.B.); and Department of Radiology, Tufts University School of Medicine, Boston, Mass (J.F.P.).
Reprint requests to Mary Cushman, MD, MSc, Department of Medicine, University of Vermont, 208 S Park Dr, Suite 2, Colchester, VT 05446. E-mail mary.cushman{at}uvm.edu
Received September 8, 2004; revision received March 9, 2005; accepted March 25, 2005.
Background— High C-reactive protein (CRP) is associated with increased coronary heart disease risk. Few long-term data in the elderly are available.
Methods and Results— Baseline CRP was measured in 3971 men and women 
65 years of age without prior vascular diseases; 26% had elevated concentrations (>3 mg/L). With 10 years of follow-up, 547 participants developed coronary heart disease (CHD; defined as myocardial infarction or coronary death). With elevated CRP, the 10-year cumulative CHD incidences were 33% in men and 17% in women. The age-, ethnicity-, and sex-adjusted relative risk of CHD for CRP >3 mg/L compared with <1 mg/L was 1.82 (95% CI, 1.46 to 2.28). Adjusting for conventional risk factors reduced the relative risk to 1.45 (95% CI, 1.14 to 1.86). The population-attributable risk of CHD for elevated CRP was 11%. Risk relationships did not differ in subgroups defined by baseline risk factors. We assessed whether CRP improved prediction by the Framingham Risk Score. Among men with a 10-year Framingham-predicted risk of 10% to 20%, the observed CHD incidence was 32% for elevated CRP. Among women, CRP discriminated best among those with a 10-year predicted risk >20%; the incidences were 31% and 10% for elevated and normal CRP levels, respectively.
Conclusions— In older men and women, elevated CRP was associated with increased 10-year risk of CHD, regardless of the presence or absence of cardiac risk factors. A single CRP measurement provided information beyond conventional risk assessment, especially in intermediate-Framingham-risk men and high-Framingham-risk women.
Key Words: coronary disease • epidemiology • inflammation • myocardial infarction • risk factors
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