C-reactive protein, fibrinogen, and cardiovascular disease prediction.
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 articleSubject
Emerging Risk Factors CollaborationHumans
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/10161/18957Published Version (Please cite this version)
10.1056/NEJMoa1107477Publication 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.
Collections
More Info
Show full item record
Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info