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C-reactive protein, fibrinogen, and cardiovascular disease prediction.

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Date
2012-10
Authors
Emerging Risk Factors Collaboration
Kaptoge, Stephen
Di Angelantonio, Emanuele
Pennells, Lisa
Wood, Angela M
White, Ian R
Gao, Pei
Walker, Matthew
Thompson, Alexander
Sarwar, Nadeem
Caslake, Muriel
Butterworth, Adam S
Amouyel, Philippe
Assmann, Gerd
Bakker, Stephan JL
Barr, Elizabeth LM
Barrett-Connor, Elizabeth
Benjamin, Emelia J
Björkelund, Cecilia
Brenner, Hermann
Brunner, Eric
Clarke, Robert
Cooper, Jackie A
Cremer, Peter
Cushman, Mary
Dagenais, Gilles R
D'Agostino, Ralph B
Dankner, Rachel
Davey-Smith, George
Deeg, Dorly
Dekker, Jacqueline M
Engström, Gunnar
Folsom, Aaron R
Fowkes, F Gerry R
Gallacher, John
Gaziano, J Michael
Giampaoli, Simona
Gillum, Richard F
Hofman, Albert
Howard, Barbara V
Ingelsson, Erik
Iso, Hiroyasu
Jørgensen, Torben
Kiechl, Stefan
Kitamura, Akihiko
Kiyohara, Yutaka
Koenig, Wolfgang
Kromhout, Daan
Kuller, Lewis H
Lawlor, Debbie A
Meade, Tom W
Nissinen, Aulikki
Nordestgaard, Børge G
Onat, Altan
Panagiotakos, Demosthenes B
Psaty, Bruce M
Rodriguez, Beatriz
Rosengren, Annika
Salomaa, Veikko
Kauhanen, Jussi
Salonen, Jukka T
Shaffer, Jonathan A
Shea, Steven
Ford, Ian
Stehouwer, Coen DA
Strandberg, Timo E
Tipping, Robert W
Tosetto, Alberto
Wassertheil-Smoller, Sylvia
Wennberg, Patrik
Westendorp, Rudi G
Whincup, Peter H
Wilhelmsen, Lars
Woodward, Mark
Lowe, Gordon DO
Wareham, Nicholas J
Khaw, Kay-Tee
Sattar, Naveed
Packard, Chris J
Gudnason, Vilmundur
Ridker, Paul M
Pepys, Mark B
Thompson, Simon G
Danesh, John
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Abstract
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.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.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.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.).
Type
Journal article
Subject
Emerging Risk Factors Collaboration
Humans
Cardiovascular Diseases
Lipids
C-Reactive Protein
Fibrinogen
Mass Screening
Prognosis
Proportional Hazards Models
Risk Factors
Cohort Studies
Adult
Middle Aged
Female
Male
Practice Guidelines as Topic
Biomarkers
Permalink
https://hdl.handle.net/10161/18957
Published Version (Please cite this version)
10.1056/NEJMoa1107477
Publication Info
Emerging Risk Factors Collaboration; Kaptoge, Stephen; Di Angelantonio, Emanuele; Pennells, Lisa; Wood, Angela M; White, Ian R; ... Danesh, John (2012). C-reactive protein, fibrinogen, and cardiovascular disease prediction. The New England journal of medicine, 367(14). pp. 1310-1320. 10.1056/NEJMoa1107477. Retrieved from https://hdl.handle.net/10161/18957.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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