Retinol-binding protein 4 and prediction of incident coronary events in healthy men and women.

CONTEXT Recent studies reported that retinol-binding protein 4 (RBP4) has a causal role in insulin resistance and suggested that its circulating levels may predict cardiovascular disease. However, the latter assumption has not yet been tested. OBJECTIVE We assessed the value of RBP4 measurement in the prediction of incident coronary artery disease (CAD). DESIGN We conducted a nested case-control study of incident CAD (n = 1036 cases vs. n = 1889 controls) selected from among 25,336 participants of the EPIC-Norfolk study. SETTING Healthy men and women, aged between 45 and 79 yr, were recruited from age-sex registers of general practices in Norfolk. PATIENTS AND OTHER PARTICIPANTS Participants completed a baseline questionnaire survey between 1993 and 1997, attended a clinic visit, and were followed for an average of 6 yr. Cases (n = 1036) were participants who developed CAD during the follow-up. Controls (n = 1889) matched by age, sex, and enrollment time remained free of any CAD during follow-up. MAIN OUTCOMES MEASURE Risk of incident fatal or nonfatal CAD according to RBP4 quartiles was assessed. RESULTS RBP4 levels were higher in cases than in controls. RBP4 levels correlated weakly with body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, and total and low-density lipoprotein-cholesterol and were inversely associated with C-reactive protein concentrations. The strongest correlation was found with triglycerides. The risk of incident CAD was associated with increasing quartiles of RBP4 levels (P = 0.03). However, adjustment for cardiovascular risk factors abolished this association. CONCLUSIONS Measurement of serum RBP4 does not provide added value for predicting CAD risk beyond traditional risk factors.

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