Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events*

The following abstracts of articles from leading journals and from the ABOG recertification examination have been selected on the basis of their importance to the practice of obstetrics and gynecology. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events* BACKGROUND: C-reactive protein (CRP) and low-density lipoprotein (LDL) cholesterol levels are both elevated in persons at risk for cardiovascular (CV) events. However, data directly comparing these two biologic markers are not available. METHODS: CRP and LDL cholesterol were measured at base line in 27,939 healthy American women. These women were then followed for a mean of eight years for the occurrence of myocardial infarction, ischemic stroke, coronary revascularization, or death from CV causes. The initial levels of CRP and LDL were analyzed to determine if they predicted the risk of CV events in the study population. RESULTS: Base line levels of both CRP and LDL cholesterol had a strong linear relation to the incidence of CV events. After adjustment for age, smoking, diabetes, blood pressure, and HRT, the relative risks of a first CV event, by quintile of CRP levels were 1.4, 1.6, 2.0, and 2.3 (P 0.001). The corresponding risks by quintile level for LDL cholesterol were 0.9, 1.1, 1.3, and 1.5 (P 0.001). Overall, 77 percent of CV events occurred in women with LDL cholesterol 160 mg per deciliter. Screening for both markers provided better prognostic information than screening for either alone. CONCLUSIONS: These data suggest that CRP levels are a stronger predictor of CV events than LDL cholesterol levels. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. N Engl J Med