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Previous Volume 347:1557-1565 November 14, 2002 Number 20 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Mosca, L. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Both C-reactive protein and low-density lipoprotein (LDL) cholesterol levels are elevated in persons at risk for cardiovascular events. However, population-based data directly comparing these two biologic markers are not available.

Methods C-reactive protein and LDL cholesterol were measured at base line in 27,939 apparently healthy American women, who were then followed for a mean of eight years for the occurrence of myocardial infarction, ischemic stroke, coronary revascularization, or death from cardiovascular causes. We assessed the value of these two measurements in predicting the risk of cardiovascular events in the study population.

Results Although C-reactive protein and LDL cholesterol were minimally correlated (r=0.08), base-line levels of each had a strong linear relation with the incidence of cardiovascular events. After adjustment for age, smoking status, the presence or absence of diabetes mellitus, categorical levels of blood pressure, and use or nonuse of hormone-replacement therapy, the relative risks of first cardiovascular events according to increasing quintiles of C-reactive protein, as compared with the women in the lowest quintile, were 1.4, 1.6, 2.0, and 2.3 (P<0.001), whereas the corresponding relative risks in increasing quintiles of LDL cholesterol, as compared with the lowest, were 0.9, 1.1, 1.3, and 1.5 (P<0.001). Similar effects were observed in separate analyses of each component of the composite end point and among users and nonusers of hormone-replacement therapy. Overall, 77 percent of all events occurred among women with LDL cholesterol levels below 160 mg per deciliter (4.14 mmol per liter), and 46 percent occurred among those with LDL cholesterol levels below 130 mg per deciliter (3.36 mmol per liter). By contrast, because C-reactive protein and LDL cholesterol measurements tended to identify different high-risk groups, screening for both biologic markers provided better prognostic information than screening for either alone. Independent effects were also observed for C-reactive protein in analyses adjusted for all components of the Framingham risk score.

Conclusions These data suggest that the C-reactive protein level is a stronger predictor of cardiovascular events than the LDL cholesterol level and that it adds prognostic information to that conveyed by the Framingham risk score.

Source Information

From the Center for Cardiovascular Disease Prevention and the Divisions of Preventive Medicine (P.M.R., L.R., J.E.B., N.R.C.) and Cardiology (P.M.R.), Brigham and Women's Hospital and Harvard Medical School; and the Department of Laboratory Medicine, Children's Hospital and Harvard Medical School (N.R.) — all in Boston.

Address reprint requests to Dr. Ridker at the Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, 900 Commonwealth Ave. East, Boston, MA 02215, or at pridker{at}partners.org.

Full Text of this Article

Related Letters:

C-Reactive Protein in the Prediction of Cardiovascular Events
Lloyd-Jones D. M., Levy D., Brezis M., Evans M. K., Zonderman A. B., Johnson W. R., Ridker P. M., Buring J. E., Cook N. R.
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N Engl J Med 2003; 348:1059-1061, Mar 13, 2003. Correspondence

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• Gozal, D., Kheirandish-Gozal, L. (2008). Cardiovascular Morbidity in Obstructive Sleep Apnea: Oxidative Stress, Inflammation, and Much More. Am. J. Respir. Crit. Care Med. 177: 369-375 [Abstract] [Full Text]  
• Pitt, B. (2008). N-terminal pro-B-type natriuretic peptide concentrations >=100 ng/l increased risk of all-cause mortality. Evid. Based Med. 13: 26-26 [Full Text]  
• Telles, R., Lanna, C., Ferreira, G., Souza, A., Navarro, T., Ribeiro, A. (2008). Carotid atherosclerotic alterations in systemic lupus erythematosus patients treated at a Brazilian university setting. Lupus 17: 105-113 [Abstract]  
• Lee, S-S., Singh, S., Magder, L., Petri, M. (2008). Predictors of high sensitivity C-reactive protein levels in patients with systemic lupus erythematosus. Lupus 17: 114-123 [Abstract]  
• Ridker, P. M, Chasman, D. I., Zee, R. Y.L., Parker, A., Rose, L., Cook, N. R., Buring, J. E, for the Women's Genome Health Study Working Group, (2008). Rationale, Design, and Methodology of the Women's Genome Health Study: A Genome-Wide Association Study of More Than 25 000 Initially Healthy American Women. Clin. Chem. 54: 249-255 [Abstract] [Full Text]  
• Packard, R. R. S., Libby, P. (2008). Inflammation in Atherosclerosis: From Vascular Biology to Biomarker Discovery and Risk Prediction. Clin. Chem. 54: 24-38 [Abstract] [Full Text]