This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (42)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular Disease/ Myocardial Infarction  • Cardiac Diagnostic Tests  • Alert me on articles by topic

The Rotterdam Study

Irene M. van der Meer, MSc; Moniek P. M. de Maat, PhD; Amanda J. Kiliaan, PhD; Deirdre A. M. van der Kuip, MD, PhD; Albert Hofman, MD, PhD; Jacqueline C. M. Witteman, PhD

Arch Intern Med. 2003;163:1323-1328.

Background  Epidemiologic studies have shown that C-reactive protein (CRP) is a risk factor for coronary heart disease. Whether routine measurement of CRP has a role in the prediction of future coronary disease in everyday clinical practice has not yet been investigated.

Methods  Within the Rotterdam Study, a population-based cohort study of 7983 men and women 55 years and older, we conducted a nested case-control study to investigate the value of CRP in coronary disease prediction. Data are based on 157 participants who experienced a myocardial infarction during follow-up and 500 randomly selected controls. High-sensitivity CRP and traditional cardiovascular risk factors were measured at baseline.

Results  The age- and sex-adjusted relative risk of myocardial infarction for subjects in the highest quartile of the population distribution of CRP compared with the lowest quartile was 2.0 (95% confidence interval, 1.1-3.4). After additional adjustment for traditional cardiovascular risk factors, the increase in risk largely disappeared (odds ratio, 1.2; 95% confidence interval, 0.6-2.2). Adding CRP to a coronary disease risk function based on risk factors that are routinely assessed in clinical practice or to the Framingham risk function did not improve the area under the receiver operating characteristic curve of these risk functions. Sensitivity and specificity of both risk functions, computed after dichotomizing the estimated disease probabilities using prespecified cutoff points, hardly improved when CRP was added.

Conclusion  Measurement of CRP in elderly people has no additional value in coronary disease risk prediction when traditional cardiovascular risk factors are known.

From the Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam (Ms van der Meer and Drs van der Kuip, Hofman, and Witteman), Gaubius Laboratory, the Netherlands Organisation for Applied Scientific Research (TNO)-Prevention and Health, Leiden (Ms van der Meer and Dr de Maat), and Numico Research, Wageningen (Dr Kiliaan), the Netherlands. The authors have no relevant financial interest in this article.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Biomarkers of inflammation predict both vascular and non-vascular mortality in older men
Clarke et al.
Eur Heart J 2008;29:800-809.
ABSTRACT | FULL TEXT  

C-reactive Protein Level and Risk of Aging Macula Disorder: The Rotterdam Study
Boekhoorn et al.
Arch Ophthalmol 2007;125:1396-1401.
ABSTRACT | FULL TEXT  

C-Reactive Protein and the Prediction of Cardiovascular Events Among Those at Intermediate Risk: Moving an Inflammatory Hypothesis Toward Consensus
Ridker
J Am Coll Cardiol 2007;49:2129-2138.
ABSTRACT | FULL TEXT  

Low-Density Lipoprotein-Dependent and -Independent Effects of Cholesterol-Lowering Therapies on C-Reactive Protein: A Meta-Analysis
Kinlay
J Am Coll Cardiol 2007;49:2003-2009.
ABSTRACT | FULL TEXT  

Inflammation and Atherothrombosis: From Population Biology and Bench Research to Clinical Practice
Libby and Ridker
J Am Coll Cardiol 2006;48:A33-A46.
ABSTRACT | FULL TEXT  

High Serum C-Reactive Protein Level Is Not an Independent Predictor for Stroke: The Rotterdam Study
Bos et al.
Circulation 2006;114:1591-1598.
ABSTRACT | FULL TEXT  

C-Reactive Protein as a Risk Predictor: Do Race/Ethnicity and Gender Make a Difference?
Albert and Ridker
Circulation 2006;114:e67-e74.
FULL TEXT  

An assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers: the atherosclerosis risk in communities study.
Folsom et al.
Arch Intern Med 2006;166:1368-1373.
ABSTRACT | FULL TEXT  

Narrative Review: Assessment of C-Reactive Protein in Risk Prediction for Cardiovascular Disease
Lloyd-Jones et al.
ANN INTERN MED 2006;145:35-42.
ABSTRACT | FULL TEXT  

C-reactive protein gene haplotypes and risk of coronary heart disease: the Rotterdam Study
Kardys et al.
Eur Heart J 2006;27:1331-1337.
ABSTRACT | FULL TEXT  

C-Reactive Protein: A New Risk Assessment Tool for Cardiovascular Disease
Clearfield
JAOA: Journal of the American Osteopathic Association 2005;105:409-416.
ABSTRACT | FULL TEXT  

C-Reactive Protein and the 10-Year Incidence of Coronary Heart Disease in Older Men and Women: The Cardiovascular Health Study
Cushman et al.
Circulation 2005;112:25-31.
ABSTRACT | FULL TEXT  

N-Terminal Pro-Brain Natriuretic Peptide, C-Reactive Protein, and Urinary Albumin Levels as Predictors of Mortality and Cardiovascular Events in Older Adults
Kistorp et al.
JAMA 2005;293:1609-1616.
ABSTRACT | FULL TEXT  

Biochemical risk markers: a novel area for better prediction of renal risk?
Stuveling et al.
Nephrol Dial Transplant 2005;20:497-508.
FULL TEXT  

Inflammatory Markers and the Risk of Coronary Heart Disease in Men and Women
Pai et al.
NEJM 2004;351:2599-2610.
ABSTRACT | FULL TEXT  

Letter Regarding Article by Ridker et al, "Should C-Reactive Protein Be Added to Metabolic Syndrome and to Assessment of Global Cardiovascular Risk?"
Lloyd-Jones and Greenland
Circulation 2004;110:e532-e532.
FULL TEXT  

Parental Cardiovascular Disease as a Risk Factor for Cardiovascular Disease in Middle-aged Adults: A Prospective Study of Parents and Offspring
Lloyd-Jones et al.
JAMA 2004;291:2204-2211.
ABSTRACT | FULL TEXT  

C-reactive protein for the prediction of cardiovascular risk: Ready for prime-time?
Hackam and Shumak
CMAJ 2004;170:1563-1565.
FULL TEXT  

Visceral fat thickness measured by ultrasonography can estimate not only visceral obesity but also risks of cardiovascular and metabolic diseases
Kim et al.
Am. J. Clin. Nutr. 2004;79:593-599.
ABSTRACT | FULL TEXT  

C-Reactive Protein Modulates Risk Prediction Based on the Framingham Score: Implications for Future Risk Assessment: Results From a Large Cohort Study in Southern Germany
Koenig et al.
Circulation 2004;109:1349-1353.
ABSTRACT | FULL TEXT  

JournalScan
Malik
Heart 2003;89:1119-1120.
FULL TEXT