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Matteo Pirro, MD; Jean Bergeron, MD; Gilles R. Dagenais, MD; Paul-Marie Bernard, MSc; Bernard Cantin, MD, PhD; Jean-Pierre Després, PhD; Benoît Lamarche, PhD

Arch Intern Med. 2001;161:2474-2480.

Background  Plasma C-reactive protein (CRP) levels recently have been identified as an emerging risk factor for ischemic heart disease (IHD). However, whether plasma CRP levels predict an increased risk for future IHD beyond traditional risk factors has yet to be evaluated in a large prospective, population-based study.

Methods  The association between elevated plasma CRP levels and the risk for future IHD was investigated in the prospective, population-based cohort of 2037 IHD-free middle-aged men from the Quebec Cardiovascular Study. During a 5-year follow-up, 105 first IHD events were recorded. Baseline plasma CRP levels were measured using a highly sensitive assay.

Results  High plasma CRP concentrations (equal to or above vs below the median level of 1.77 mg/L) were associated with a significant 1.8-fold increase in IHD risk (95% confidence interval [CI], 1.2-2.7). This association remained significant after adjustment for lipid risk factors but not when the simultaneous contribution of nonlipid traditional risk factors was taken into account. Multivariate analyses indicated that CRP level predicted short-term risk for IHD (events that occurred 2 years after the baseline evaluation), but not long-term risk (>2 years). Moreover, high plasma CRP levels predicted an increased risk for IHD, independent of any other confounder, in younger (55 years) but not in older (>55 years) individuals.

Conclusion  Plasma CRP levels may provide independent information on IHD risk only in younger middle-aged men and in the case of IHD events that may occur relatively soon after the baseline evaluation.

From the Lipid Research Center, Laval University Hospital Research Center (Drs Pirro, Bergeron, Cantin, Després, and Lamarche), the Québec Heart Institute, Laval Hospital (Drs Dagenais, Cantin, and Després), and the Department of Social and Preventive Medicine, Laval University (Mr Bernard), Québec City, Québec.

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