Proposed cardiovascular risk assessment algorithm using high-sensitivity C-reactive protein and lipid screening.

Several prospective epidemiologic studies from the United States and Europe have demonstrated that high-sensitivity C-reactive protein (hs-CRP) is a predictor of future coronary events among apparently healthy men and women. For example, findings from the Multiple Risk Factors Intervention Trial demonstrated a correlation between hs-CRP and coronary heart disease mortality among male smokers followed over a 17-year period \[relative risk (RR) = 2.8; 95% confidence interval (CI), 1.4–5.4\] (1). A similar positive association between hs-CRP and future coronary events was noted in the Cardiovascular Health Study and Rural Health Promotion Project, which included elderly men and women with subclinical cardiovascular disease (2). A direct positive association between hs-CRP and future coronary events was also reported in apparently healthy men from the Physician’s Health Study (PHS); those in the highest quartile of hs-CRP had twice the risk of future stroke (RR = 1.9; 95% CI, 1.1–3.3), three times the risk of future myocardial infarction (RR = 2.9; 95% CI, 1.8–4.6), and four times the risk of future peripheral vascular disease (RR = 4.1; 95% CI, 1.2–6.0) (3)(4). Furthermore, both the MONICA-Augsburg cohort (5) and the Helsinki Heart Study (6) showed that compared with those with low hs-CRP, individuals with the highest hs-CRP concentrations were at approximately three times the risk of developing future coronary events. Finally, two reports from the Women’s Health Study (WHS) showed that hs-CRP is also a strong predictor of future cardiovascular events in women (RR = 4.4; 95% CI, 2.2–8.9) (7)(8). In fact, in that study, which directly compared several novel risk factors to standard lipid screening, hs-CRP was the single strongest predictor of future vascular risk …

[1]  P. Ridker,et al.  Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. , 1997, The New England journal of medicine.

[2]  M. Pfeffer,et al.  Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events (CARE) Investigators. , 1998, Circulation.

[3]  S. Yusuf,et al.  Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. , 2000 .

[4]  P. Ridker,et al.  Plasma concentration of C-reactive protein and risk of developing peripheral vascular disease. , 1998, Circulation.

[5]  Kukin Ml.  The Heart Outcomes Prevention Evaluation Study. , 2001, Current cardiology reports.

[6]  P. Ridker,et al.  C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. , 2000, The New England journal of medicine.

[7]  L. Kuller,et al.  Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Multiple Risk Factor Intervention Trial. , 1996, American journal of epidemiology.

[8]  A. Döring,et al.  C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. , 1999, Circulation.

[9]  L H Kuller,et al.  Relationship of C-reactive protein to risk of cardiovascular disease in the elderly. Results from the Cardiovascular Health Study and the Rural Health Promotion Project. , 1997, Arteriosclerosis, thrombosis, and vascular biology.

[10]  E. Braunwald.  Shattuck lecture--cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. , 1997, The New England journal of medicine.

[11]  N Rifai,et al.  Clinical efficacy of an automated high-sensitivity C-reactive protein assay. , 1999, Clinical chemistry.

[12]  K. Williams,et al.  Atherosclerosis--an inflammatory disease. , 1999, The New England journal of medicine.

[13]  M. Pfeffer,et al.  Long-Term Effects of Pravastatin on Plasma Concentration of C-reactive Protein , 1999 .

[14]  M. Leinonen,et al.  Infections, inflammation, and the risk of coronary heart disease. , 2000, Circulation.

[15]  P. Ridker,et al.  Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. , 1998, Circulation.

[16]  R J Glynn,et al.  C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. , 1998, Circulation.