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C-reactive protein, fibrinogen, and cardiovascular disease prediction.

TitleC-reactive protein, fibrinogen, and cardiovascular disease prediction.
Publication TypeJournal Article
Year of Publication2012
AuthorsKaptoge S, Di Angelantonio E, Pennells L, Wood AM, White IR, Gao P, Walker M, Thompson A, Sarwar N, Caslake M, Butterworth AS, Amouyel P, Assmann G, Bakker SJL, Barr ELM, Barrett-Connor E, Benjamin EJ, Björkelund C, Brenner H, Brunner E, Clarke R, Cooper JA, Cremer P, Cushman M, Dagenais GR, D'Agostino RB, Dankner R, Davey-Smith G, Deeg D, Dekker JM, Engström G, Folsom AR, F Fowkes GR, Gallacher J, J Gaziano M, Giampaoli S, Gillum RF, Hofman A, Howard BV, Ingelsson E, Iso H, Jørgensen T, Kiechl S, Kitamura A, Kiyohara Y, Koenig W, Kromhout D, Kuller LH, Lawlor DA, Meade TW, Nissinen A, Nordestgaard BG, Onat A, Panagiotakos DB, Psaty BM, Rodriguez B, Rosengren A, Salomaa V, Kauhanen J, Salonen JT, Shaffer JA, Shea S, Ford I, Stehouwer CDA, Strandberg TE, Tipping RW, Tosetto A, Wassertheil-Smoller S, Wennberg P, Westendorp RG, Whincup PH, Wilhelmsen L, Woodward M, Lowe GDO, Wareham NJ, Khaw K-T, Sattar N, Packard CJ, Gudnason V, Ridker PM, Pepys MB, Thompson SG, Danesh J
Corporate AuthorsEmerging Risk Factors Collaboration
JournalN Engl J Med
Volume367
Issue14
Pagination1310-20
Date Published2012 Oct 04
ISSN1533-4406
KeywordsAdult, Biomarkers, C-Reactive Protein, Cardiovascular Diseases, Cohort Studies, Female, Fibrinogen, Humans, Lipids, Male, Mass Screening, Middle Aged, Practice Guidelines as Topic, Prognosis, Proportional Hazards Models, Risk Factors
Abstract

BACKGROUND: There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events.

METHODS: We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen.

RESULTS: The addition of information on high-density lipoprotein cholesterol to a prognostic model for cardiovascular disease that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (P

CONCLUSIONS: In a study of people without known cardiovascular disease, we estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened. (Funded by the British Heart Foundation and others.).

DOI10.1056/NEJMoa1107477
Alternate JournalN Engl J Med
PubMed ID23034020
PubMed Central IDPMC3714101
Grant ListMC_U137686851 / / Medical Research Council / United Kingdom
G0600705 / / Medical Research Council / United Kingdom
G19/35 / / Medical Research Council / United Kingdom
PG/09/002/26056 / / British Heart Foundation / United Kingdom
G0100222 / / Medical Research Council / United Kingdom
RG/08/014/24067 / / British Heart Foundation / United Kingdom
G8802774 / / Medical Research Council / United Kingdom
G1000143 / / Medical Research Council / United Kingdom
RG/08/013/25942 / / British Heart Foundation / United Kingdom
G0902037 / / Medical Research Council / United Kingdom
MC_U137686857 / / Medical Research Council / United Kingdom
P01 HL088117 / HL / NHLBI NIH HHS / United States
MC_U106179471 / / Medical Research Council / United Kingdom
G0701863 / / Medical Research Council / United Kingdom
K24 HL084034 / HL / NHLBI NIH HHS / United States
G7900510 / / Medical Research Council / United Kingdom
R01 HL091099 / HL / NHLBI NIH HHS / United States
G0701619 / / Medical Research Council / United Kingdom
RG/08/014 / / British Heart Foundation / United Kingdom
MC_U105260792 / / Medical Research Council / United Kingdom
MC_U105260558 / / Medical Research Council / United Kingdom
RG/07/008/23674 / / British Heart Foundation / United Kingdom