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The value of C-reactive protein in cardiovascular risk prediction: the Rotterdam Study
Irene M van der Meer1, Moniek P M de Maat, Amanda J Kiliaan
1Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands.
Insights
Routine measurement of C-reactive protein (CRP) does not improve coronary heart disease prediction in elderly individuals when traditional risk factors are known. This study found no additional value of CRP for predicting future cardiac events in this population.
Area of Science:
- Cardiovascular epidemiology
- Biomarker research
- Preventive cardiology
Background:
- Epidemiologic studies identify C-reactive protein (CRP) as a risk factor for coronary heart disease (CHD).
- The clinical utility of routine CRP measurement for predicting future CHD remains uninvestigated.
Purpose of the Study:
- To investigate the predictive value of high-sensitivity C-reactive protein (hs-CRP) for coronary heart disease in an elderly population.
- To determine if hs-CRP adds incremental value to traditional cardiovascular risk factors in predicting myocardial infarction.
Main Methods:
- A nested case-control study within the population-based Rotterdam Study (n=7983, aged ≥55 years).
- Included 157 myocardial infarction cases and 500 controls.
- Measured hs-CRP and traditional cardiovascular risk factors at baseline.
Main Results:
- Age- and sex-adjusted relative risk of myocardial infarction for the highest CRP quartile was 2.0 (95% CI, 1.1-3.4).
- This increased risk diminished after adjusting for traditional risk factors (OR, 1.2; 95% CI, 0.6-2.2).
- Adding CRP to existing risk functions did not improve predictive accuracy (AUC, sensitivity, specificity).
Conclusions:
- Measurement of CRP offers no additional value in predicting coronary heart disease in elderly individuals when traditional cardiovascular risk factors are known.
- Routine CRP testing is not recommended for enhancing coronary disease risk prediction in this demographic.
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.