on June 27, 2005
Published online before print June 27, 2005, doi: 10.1161/CIRCULATIONAHA.104.504159
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Submitted on September 8, 2004
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.). * To whom correspondence should be addressed. E-mail: mary.cushman{at}uvm.edu.
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 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.
Revised on March 9, 2005
Accepted on March 25, 2005
C-Reactive Protein and the 10-Year Incidence of Coronary Heart Disease in Older Men and Women. The Cardiovascular Health Study
Mary Cushman MD, MSc*,
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.
Key words: coronary disease • epidemiology • inflammation • myocardial infarction • risk factors
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