Abstract 814: CRP and Risk of Vascular Events in PROSPER
Background: The role of C-reactive protein (CRP) in predicting global vascular events and response to statin therapy remains uncertain and thus additional large prospective studies are required.
Methods: Baseline CRP was related to risk for primary combined endpoint (definite or suspect death from CHD, non-fatal MI and fatal or non-fatal stroke, n=865 events), secondary (CHD events or stroke alone) and tertiary end-point (stroke plus TIAs) in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). Extent of CVD prediction by CRP beyond conventional risk was also assessed.
Results: CRP levels were higher in subjects who had a subsequent primary end-point event in comparisons to those who did not [geometric mean 3.64 (SD 3.08) vs. 3.01 (3.05) mg/l, P<0.0001]. CRP correlated with BMI and smoking status, and negatively with HDL-cholesterol. The unadjusted hazard ratio for primary end-point was 1.48 (95% CI 1.26 to 1.74), in a comparison of top versus bottom tertile for CRP (Figure 1⇓), falling to 1.36 (1.15 to 1.61) with adjustment for conventional risk predictors and BMI. Similar results were obtained for other end-points or when results were examined separately by history of vascular disease. However, despite this independent prediction, CRP added minimally to risk prediction beyond conventional predictors, as judged by ROC analysis, and did not predict response to statin therapy for any end-point.
Conclusions: CRP did not enhance CVD prediction beyond established vascular risk factors, nor did it predict response to statin therapy in elderly subjects at risk. These data suggest CRP has limited value in predicting CVD risk or response to statin therapy in elderly people.