C-Reactive Protein, Fibrinogen, and Cardiovascular Disease Prediction

S Kaptoge, E Di Angelantonio, L Pennells, AM Wood, IR White, P Gao, M Walker, A Thompson, N Sarwar, M Caslake, AS Butterworth, P Amouyel, G Assmann, SJL Bakker, ELM Barr, E Barrett-Connor, EJ Benjamin, C Bjorkelund, H Brenner, E BrunnerR Clarke, JA Cooper, P Cremer, M Cushman, GR Dagenais, RB D'Agostino, R Dankner, G Davey-Smith, D Deeg, JM Dekker, G Engstrom, AR Folsom, FGR Fowkes, J Gallacher, JM Gaziano, S Giampaoli, RF Gillum, Bert Hofman, BV Howard, E Ingelsson, H Iso, T Jorgensen, S Kiechl, A Kitamura, Y Kiyohara, W Koenig, D Kromhout, LH Kuller, DA Lawlor, TW Meade, A Nissinen, BG Nordestgaard, A Onat, DB Panagiotakos, BM Psaty, B Rodriguez, A Rosengren, V Salomaa, J Kauhanen, JT Salonen, JA Shaffer, S Shea, I Ford, CDA Stehouwer, TE Strandberg, RW Tipping, A Tosetto, S Wassertheil-Smoller, P Wennberg, RG Westendorp, PH Whincup, L Wilhelmsen, M Woodward, GDO Lowe, NJ Wareham, KT Khaw, N Sattar, CJ Packard, V Gudnason, PM Ridker, MB Pepys, SG Thompson, J Danesh

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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 < 0.001), and yielded a net reclassification improvement of 1.52% and 0.83%, re 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.)
Original languageUndefined/Unknown
Pages (from-to)1310-1320
Number of pages11
JournalNew England Journal of Medicine
Volume367
Issue number14
DOIs
Publication statusPublished - 2012

Research programs

  • EMC NIHES-01-64-01

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