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C-reactive protein, fibrin D-dimer, and risk of ischemic heart disease: the Caerphilly and Speedwell studies
G D O Lowe1, P M Sweetnam, J W G Yarnell
1Department of Medicine, University of Glasgow, Scotland, UK. gdl1j@clinmed.gla.ac.uk
Insights
C-reactive protein (CRP) and fibrin D-dimer are significant predictors of ischemic heart disease (IHD). These markers, indicating inflammation and clotting, show additive effects on coronary risk.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Epidemiology
Background:
- Growing interest in C-reactive protein (CRP) and fibrin D-dimer for predicting ischemic heart disease (IHD).
- Need to assess joint and independent associations of these markers with IHD risk.
Purpose of the Study:
- To evaluate the predictive value of CRP and D-dimer for IHD.
- To determine if these markers have independent or additive effects on coronary risk.
Main Methods:
- Analysis of two large population cohorts (Caerphilly and Speedwell) involving men aged 49-66.
- Baseline measurement of CRP and D-dimer, with follow-up for new IHD events over approximately 75-105 months.
- Statistical analysis including relative odds and multivariate models.
Main Results:
- Significantly higher mean levels of CRP and D-dimer in men who developed IHD.
- Top 20% CRP levels associated with 2.97-fold odds of IHD; top 20% D-dimer levels associated with 2.40-fold odds.
- Evidence of additive effects between CRP and D-dimer on IHD risk, with D-dimer remaining significant after multivariate adjustment.
Conclusions:
- Both inflammatory (CRP) and thrombogenic (D-dimer) markers are crucial predictors of coronary risk.
- These markers may have additive effects, enhancing their predictive power for IHD.
Background:
There is increasing interest in the predictive value of C-reactive protein (CRP) and fibrin D-dimer in the prediction of ischemic heart disease (IHD). We assessed their joint and independent associations with IHD in a large combined analysis of 2 population cohorts.
Methods And Results:
Men aged 49 to 66 years from the general populations of Caerphilly and Speedwell were studied between 1982 and 1988 and re-examined for new IHD events at fixed intervals of approximately 105 months (Caerphilly) and 75 months (Speedwell). 3213 men had CRP and D-dimer measured at baseline and 351 (11%) had a new IHD event. Mean levels of CRP and D-dimer were significantly higher among men in whom IHD developed. The relative odds of IHD in men in the top 20% of the distribution of CRP was 2.97 (95% CI, 2.04, 4.32) and for D-dimer was 2.40 (95% CI, 1.69, 3.40); CRP and D-dimer had additive effects on risk of IHD. Multivariate analysis reduced the size of the relative odds, which remained significant for D-dimer.
Conclusions:
Both inflammatory and thrombogenic markers are important (and potentially additive) predictors of coronary risk.
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