Related Experiment Video
Updated: May 5, 2026
A Middle Cerebral Artery Occlusion Technique for Inducing Post-stroke Depression in Rats
Published on: May 22, 2019
High serum C-reactive protein level is not an independent predictor for stroke: the Rotterdam Study
Michiel J Bos1, C Maarten A Schipper, Peter J Koudstaal
1Department of Epidemiology and Biostatistics, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
Insights
High C-reactive protein (CRP) levels are linked to increased stroke risk, but do not improve individual stroke risk prediction. This finding impacts cardiovascular risk assessment strategies.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Current guidelines suggest high-sensitivity C-reactive protein (hs-CRP) for cardiovascular risk prediction.
- Emerging evidence questions the predictive value of CRP despite its association with cardiovascular disease.
- The study investigates CRP's role as both a risk factor and predictor for future stroke.
Purpose of the Study:
- To determine if C-reactive protein (CRP) levels are associated with the risk of future stroke.
- To evaluate the utility of CRP in predicting individual stroke risk.
Main Methods:
- Utilized data from 6430 participants (age ≥55, stroke-free at baseline) in the Rotterdam Study (1990-1993).
- Assessed stroke risk variation with baseline CRP serum levels using Cox proportional hazards models.
- Evaluated CRP's predictive accuracy for individual stroke risk via receiver operating characteristic curves.
Main Results:
- Over 8.2 years, 498 first-ever strokes occurred.
- Elevated CRP levels showed a significant association with the risk of any stroke (HR 1.14) and ischemic stroke (HR 1.17).
- Incorporating CRP levels did not enhance individual stroke risk prediction accuracy, even when combined with established scores like the Framingham stroke risk score.
Conclusions:
- C-reactive protein (CRP) levels are demonstrably associated with an increased risk of stroke.
- The clinical utility of CRP for assessing individual stroke risk appears limited.
- Further research may be needed to clarify CRP's role in stroke risk stratification.
Background:
Current guidelines recommend the assessment of C-reactive protein (CRP) levels with a high-sensitivity assay in cardiovascular risk prediction. Recent studies have put forward that although elevated CRP is a risk factor for cardiovascular disease, it is not helpful in the prediction of cardiovascular disease risk. We studied the importance of CRP as a risk factor and as a risk predictor of future stroke.
Methods And Results:
The present study was based on 6430 participants of the Rotterdam Study who at baseline (1990-1993) were > or = 55 years of age, were stroke free, and had blood taken. Strokes were classified as hemorrhagic, ischemic, or unspecified. Ischemic strokes were further subclassified. Whether stroke risk varied with baseline CRP serum levels was assessed with Cox proportional hazards models. Whether CRP was helpful in the prediction of individual stroke risk was assessed with receiver operating characteristic curves and by comparing the distribution of strokes between predicted risk strata. During an average of 8.2 years of follow-up, 498 first-ever strokes occurred. High CRP levels were significantly associated with risk of any stroke (age- and sex-adjusted hazard ratio per SD, 1.14; 95% confidence interval, 1.04 to 1.24) and risk of ischemic stroke (age- and sex-adjusted hazard ratio per SD, 1.17; 95% confidence interval, 1.04 to 1.32). Taking CRP levels into account did not improve the individual stroke risk prediction, however, regardless of whether it was based on the Framingham stroke risk score or on age and sex only.
Conclusions:
Although CRP levels are associated with stroke risk, their use in the assessment of individual stroke risk seems limited.
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:26Atherosclerosis III: Management