Document Detail


C-reactive protein, fibrinogen, and cardiovascular disease prediction.
MedLine Citation:
PMID:  23034020     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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%, respectively, for the predicted 10-year risk categories of "low" (<10%), "intermediate" (10% to <20%), and "high" (≥20%) (P<0.02 for both comparisons). We estimated that among 100,000 adults 40 years of age or older, 15,025 persons would initially be classified as being at intermediate risk for a cardiovascular event if conventional risk factors alone were used to calculate risk. Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines (i.e., for persons with a predicted risk of ≥20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years.
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.).
Authors:
; Stephen Kaptoge; Emanuele Di Angelantonio; Lisa Pennells; Angela M Wood; Ian R White; Pei Gao; Matthew Walker; Alexander Thompson; Nadeem Sarwar; Muriel Caslake; Adam S Butterworth; Philippe Amouyel; Gerd Assmann; Stephan J L Bakker; Elizabeth L M Barr; Elizabeth Barrett-Connor; Emelia J Benjamin; Cecilia Björkelund; Hermann Brenner; Eric Brunner; Robert Clarke; Jackie A Cooper; Peter Cremer; Mary Cushman; Gilles R Dagenais; Ralph B D'Agostino; Rachel Dankner; George Davey-Smith; Dorly Deeg; Jacqueline M Dekker; Gunnar Engström; Aaron R Folsom; F Gerry R Fowkes; John Gallacher; J Michael Gaziano; Simona Giampaoli; Richard F Gillum; Albert Hofman; Barbara V Howard; Erik Ingelsson; Hiroyasu Iso; Torben Jørgensen; Stefan Kiechl; Akihiko Kitamura; Yutaka Kiyohara; Wolfgang Koenig; Daan Kromhout; Lewis H Kuller; Debbie A Lawlor; Tom W Meade; Aulikki Nissinen; Børge G Nordestgaard; Altan Onat; Demosthenes B Panagiotakos; Bruce M Psaty; Beatriz Rodriguez; Annika Rosengren; Veikko Salomaa; Jussi Kauhanen; Jukka T Salonen; Jonathan A Shaffer; Steven Shea; Ian Ford; Coen D A Stehouwer; Timo E Strandberg; Robert W Tipping; Alberto Tosetto; Sylvia Wassertheil-Smoller; Patrik Wennberg; Rudi G Westendorp; Peter H Whincup; Lars Wilhelmsen; Mark Woodward; Gordon D O Lowe; Nicholas J Wareham; Kay-Tee Khaw; Naveed Sattar; Chris J Packard; Vilmundur Gudnason; Paul M Ridker; Mark B Pepys; Simon G Thompson; John Danesh
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  367     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-04     Completed Date:  2012-10-16     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1310-20     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Biological Markers / blood
C-Reactive Protein / metabolism*
Cardiovascular Diseases / blood,  prevention & control*
Cohort Studies
Female
Fibrinogen / metabolism*
Humans
Lipids / blood
Male
Mass Screening
Middle Aged
Practice Guidelines as Topic
Prognosis
Proportional Hazards Models
Risk Factors
Grant Support
ID/Acronym/Agency:
G0600705//Medical Research Council; G0701619//Medical Research Council; G0701863//Medical Research Council; G0902037//Medical Research Council; G1000143//Medical Research Council; G19/35//Medical Research Council; G7900510//Medical Research Council; G8802774//Medical Research Council; K24 HL084034/HL/NHLBI NIH HHS; MC_U105260558//Medical Research Council; MC_U105260792//Medical Research Council; MC_U106179471//Medical Research Council; MC_U137686851//Medical Research Council; P01 HL088117/HL/NHLBI NIH HHS; PG/09/002/26056//British Heart Foundation; R01 HL091099/HL/NHLBI NIH HHS; RG/07/008/23674//British Heart Foundation; RG/08/013/25942//British Heart Foundation; RG/08/014//British Heart Foundation; RG/08/014/24067//British Heart Foundation; //Medical Research Council
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Lipids; 9001-32-5/Fibrinogen; 9007-41-4/C-Reactive Protein
Investigator
Investigator/Affiliation:
Stephen Kaptoge / ; Emanuele Di Angelantonio / ; Lisa Pennells / ; Angela M Wood / ; Ian R White / ; Pei Gao / ; Matthew Walker / ; Alexander Thompson / ; Nadeem Sarwar / ; Muriel Caslake / ; Adam S Butterworth / ; Philippe Amouyel / ; Gerd Assmann / ; Stephan J L Bakker / ; Elizabeth L M Barr / ; Elizabeth Barrett-Connor / ; Emelia J Benjamin / ; Cecilia Björkelund / ; Hermann Brenner / ; Eric Brunner / ; Robert Clarke / ; Jackie A Cooper / ; Peter Cremer / ; Mary Cushman / ; Gilles R Dagenais / ; Ralph B D'Agostino / ; Rachel Dankner / ; George Davey-Smith / ; Dorly Deeg / ; Jacqueline M Dekker / ; Gunnar Engström / ; Aaron R Folsom / ; F Gerry R Fowkes / ; John Gallacher / ; J Michael Gaziano / ; Simona Giampaoli / ; Richard F Gillum / ; Albert Hofman / ; Barbara V Howard / ; Erik Ingelsson / ; Hiroyasu Iso / ; Torben Jørgensen / ; Stefan Kiechl / ; Akihiko Kitamura / ; Yutaka Kiyohara / ; Wolfgang Koenig / ; Daan Kromhout / ; Lewis H Kuller / ; Debbie A Lawlor / ; Tom W Meade / ; Aulikki Nissinen / ; Børge G Nordestgaard / ; Altan Onat / ; Demosthenes B Panagiotakos / ; Bruce M Psaty / ; Beatriz Rodriguez / ; Annika Rosengren / ; Veikko Salomaa / ; Jussi Kauhanen / ; Jukka T Salonen / ; Jonathan A Shaffer / ; Steven Shea / ; Ian Ford / ; Coen D A Stehouwer / ; Timo E Strandberg / ; Robert W Tipping / ; Alberto Tosetto / ; Sylvia Wassertheil-Smoller / ; Patrik Wennberg / ; Rudi G Westendorp / ; Peter H Whincup / ; Lars Wilhelmsen / ; Mark Woodward / ; Gordon D O Lowe / ; Nicholas J Wareham / ; Kay-Tee Khaw / ; Naveed Sattar / ; Chris J Packard / ; Vilmundur Gudnason / ; Paul M Ridker / ; Mark B Pepys / ; Simon G Thompson / ; John Danesh / ; Robert W Tipping / ; Aaron R Folsom / ; Lloyd E Chambless / ; Christie M Ballantyne / ; Brad C Astor / ; Demosthenes B Panagiotakos / ; Christos Pitsavos / ; Christina Chrysohoou / ; Christodoulos Stefanadis / ; Robert Atkins / ; Elizabeth L M Barr / ; Jonathan E Shaw / ; Paul Z Zimmet / ; Peter H Whincup / ; S Goya Wannamethee / ; Richard W Morris / ; Stefan Kiechl / ; Johann Willeit / ; Agnes Mayr / ; Georg Schett / ; Shah Ebrahim / ; Debbie A Lawlor / ; John W Yarnell / ; John Gallacher / ; Mary Cushman / ; Bruce M Psaty / ; Russ Tracy / ; Anne Tybjærg-Hansen / ; Ruth Frikke-Schmidt / ; Marianne Benn / ; Børge G Nordestgaard / ; Simona Giampaoli / ; Luigi Palmieri / ; Salvatore Panico / ; Diego Vanuzzo / ; Lorenza Pilotto / ; F Gerry R Fowkes / ; Amanda J Lee / ; Kay-Tee Khaw / ; Nicholas J Wareham / ; Hermann Brenner / ; Ben Schöttker / ; Heiko Müller / ; Dietrich Rothenbacher / ; Jan-Håkan Jansson / ; Patrik Wennberg / ; Aulikki Nissinen / ; Chiara Donfrancesco / ; Simona Giampaoli / ; Veikko Salomaa / ; Kennet Harald / ; Pekka Jousilahti / ; Erkki Vartiainen / ; Mark Woodward / ; Ralph B D'Agostino / ; Philip A Wolf / ; Emelia J Benjamin / ; Michael J Pencina / ; Ralph B D'Agostino / ; Philip A Wolf / ; Ramachandran S Vasan / ; Emelia J Benjamin / ; Else-Marie Bladbjerg / ; Torben Jørgensen / ; Lars Møller / ; Jørgen Jespersen / ; Rachel Dankner / ; Angela Chetrit / ; Flora Lubin / ; Lars Wilhelmsen / ; Henry Eriksson / ; Kurt Svärdsudd / ; Lennart Welin / ; Annika Rosengren / ; Lars Wilhelmsen / ; Georgios Lappas / ; Henry Eriksson / ; Cecilia Björkelund / ; Lauren Lissner / ; Calle Bengtsson / ; Peter Cremer / ; Dorothea Nagel / ; Reijo S Tilvis / ; Timo E Strandberg / ; Yutaka Kiyohara / ; Hisatomi Arima / ; Yasufumi Doi / ; Toshiharu Ninomiya / ; Beatriz Rodriguez / ; Jacqueline M Dekker / ; Giel Nijpels / ; Coen D A Stehouwer / ; Hiroyasu Iso / ; Akihiko Kitamura / ; Kazumasa Yamagishi / ; Hiroyuki Noda / ; Jussi Kauhanen / ; Jukka T Salonen / ; Dorly Deeg / ; Marijke A Bremmer / ; Tom W Meade / ; Jackie A Cooper / ; Bo Hedblad / ; Peter Nilsson / ; Gunnar Engström / ; Mary Cushman / ; Aaron R Folsom / ; Bruce M Psaty / ; Steven Shea / ; Angela Döring / ; Wolfgang Koenig / ; Christa Meisinger / ; Lars Wilhelmsen / ; Annika Rosengren / ; Georgios Lappas / ; Lewis H Kuller / ; Greg Grandits / ; Richard F Gillum / ; Michael Mussolino / ; Tom W Meade / ; Jackie A Cooper / ; Christine Knottenbelt / ; Jackie A Cooper / ; Kenneth A Bauer / ; Karina W Davidson / ; Susan Kirkland / ; Jonathan A Shaffer / ; Daichi Shimbo / ; Akihiko Kitamura / ; Hiroyasu Iso / ; Shinichi Sato / ; Stephan J L Bakker / ; Ron T Gansevoort / ; Hans L Hillege / ; Philippe Amouyel / ; Dominique Arveiler / ; Alun Evans / ; Jean Ferrières / ; Helmut Schulte / ; Gerd Assmann / ; Chris J Packard / ; Naveed Sattar / ; Rudi G Westendorp / ; Brendan M Buckley / ; Bernard Cantin / ; Benoît Lamarche / ; Jean-Pierre Després / ; Gilles R Dagenais / ; Elizabeth Barrett-Connor / ; Deborah L Wingard / ; Richele Bettencourt / ; Vilmundur Gudnason / ; Thor Aspelund / ; Gunnar Sigurdsson / ; Bolli Thorsson / ; Gudny Eiriksdottir / ; Jacqueline Witteman / ; Isabella Kardys / ; Abbas Dehghan / ; Albert Hofman / ; Hugh Tunstall-Pedoe / ; Roger Tavendale / ; Gordon D O Lowe / ; Mark Woodward / ; Barbara V Howard / ; Ying Zhang / ; Lyle Best / ; Jason Umans / ; Yoav Ben-Shlomo / ; George Davey-Smith / ; Altan Onat / ; Günay Can / ; Tom W Meade / ; Erik Ingelsson / ; Samar Basu / ; Tommy Cederholm / ; Liisa Byberg / ; J Michael Gaziano / ; Meir Stampfer / ; Paul M Ridker / ; J Michael Gaziano / ; Paul M Ridker / ; Alberto Tosetto / ; Francesco Rodeghiero / ; Sylvia Wassertheil-Smoller / ; Robert Kaplan / ; Charles Kooperberg / ; Michael Marmot / ; Robert Clarke / ; Rory Collins / ; Astrid Fletcher / ; Eric Brunner / ; Martin Shipley / ; Mika Kivimäki / ; Paul M Ridker / ; Julie Buring / ; Nancy Cook / ; Ian Ford / ; James Shepherd / ; Stuart M Cobbe / ; Michele Robertson / ; Edith J M Feskens / ; Daan Kromhout / ; Matthew Walker / ; Sarah Watson / ; Myriam Alexander / ; Adam S Butterworth / ; Emanuele Di Angelantonio / ; Oscar H Franco / ; Pei Gao / ; Reeta Gobin / ; Philip Haycock / ; Stephen Kaptoge / ; Sreenivasa R Kondapally Seshasai / ; Sarah Lewington / ; Lisa Pennells / ; Eleni Rapsomaniki / ; Nadeem Sarwar / ; Alexander Thompson / ; Simon G Thompson / ; Matthew Walker / ; Sarah Watson / ; Ian R White / ; Angela M Wood / ; David Wormser / ; Xiaohui Zhao / ; John Danesh /
Comments/Corrections
Comment In:
N Engl J Med. 2013 Jan 3;368(1):85   [PMID:  23281990 ]
N Engl J Med. 2013 Jan 3;368(1):85-6   [PMID:  23281988 ]
N Engl J Med. 2013 Jan 3;368(1):85   [PMID:  23281991 ]
N Engl J Med. 2013 Jan 3;368(1):84-5   [PMID:  23281989 ]

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