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  Vol. 165 No. 21, November 28, 2005 TABLE OF CONTENTS
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C-Reactive Protein and Risk of Cardiovascular Disease in Men and Women From the Framingham Heart Study

Peter W. F. Wilson, MD; Byung-Ho Nam, PhD; Michael Pencina, PhD; Ralph B. D’Agostino Sr, PhD; Emelia J. Benjamin, MD, MS; Christopher J. O’Donnell, MD, MPH

Arch Intern Med. 2005;165:2473-2478.

Background  Determination of C-reactive protein (CRP) level has been suggested to improve cardiovascular disease (CVD) risk assessment. This study examines the utility of CRP levels to assess CVD risk in a community setting.

Methods  We performed a prospective observational cohort study on a community population sample. A total of 1949 men and 2497 women without CVD from the Framingham Heart Study underwent CVD risk factor assessment. Initial CVD events during 8 years of follow-up were recorded.

Results  There were 283 major CVD and 160 major coronary heart disease incident events. Age-, sex-, and multivariable-adjusted analyses generally used CRP level categories of less than 1, 1 to 3, and greater than 3 mg/L. In age- and sex-adjusted models, the traditional risk factors and elevated CRP levels indicated increased risk. The age- and sex-adjusted relative risk (RR) and 95% confidence interval (CI) of CRP level greater than 3 mg/L for major CVD was elevated (RR, 1.60; 95% CI, 1.19-2.14), with evidence of attenuation (RR, 1.22; 95% CI, 0.90-1.66) in multivariable models. The C statistic, a measure of the discriminatory capability of the prediction models, was 0.74 for prediction of major CVD with age and CRP level. In multivariable models that included traditional risk factors, the C statistic was 0.78, a value that was unchanged with the addition of CRP to the multivariable model. Similar relations were noted for major coronary heart disease events.

Conclusion  Elevated CRP level provided no further prognostic information beyond traditional office risk factor assessment to predict future major CVD and major coronary heart disease in this population sample.


Author Affiliations: General Clinical Research Center, Medical University of South Carolina, Charleston (Dr Wilson); Department of Mathematics (Drs Nam, Pencina, and D’Agostino) and Department of Cardiology, School of Medicine (Dr Benjamin), Boston University, Boston, Mass; and the National Heart, Lung, and Blood Institute’s Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Mass (Dr O’Donnell).



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RELATED LETTERS

The Role of Inflammation for Heart Disease Risk Cannot Be Determined by Correlations Between C-Reactive Protein and Risk Factors—Reply
Michael Miller and Stephen Havas
Arch Intern Med. 2006;166(9):1040-1041.
EXTRACT | FULL TEXT  

C-Reactive Protein and Cardiovascular Risk in the Framingham Study
Paul Ridker, Nader Rifai, Wolfgang Koenig, and Roger S. Blumenthal
Arch Intern Med. 2006;166(12):1327-1328.
EXTRACT | FULL TEXT  

C-Reactive Protein and Cardiovascular Risk in the Framingham Study—Reply
Peter W. F. Wilson, Michael Pencina, Ralph B. D’Agostino, Sr, and Christopher J. O’Donnell
Arch Intern Med. 2006;166(12):1328.
EXTRACT | FULL TEXT  

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Arch Intern Med. 2005;165(21):2454-2456.
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Lipoprotein-Associated Phospholipase A2, High-Sensitivity C-Reactive Protein, and Risk for Incident Ischemic Stroke in Middle-aged Men and Women in the Atherosclerosis Risk in Communities (ARIC) Study
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Arch Intern Med. 2005;165(21):2479-2484.
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