Utility of C-reactive protein for cardiovascular risk stratification across three age groups in subjects without...

Area of Science:

• Cardiology
• Preventive Medicine
• Epidemiology

Background:

• The predictive utility of established cardiovascular disease (CVD) risk factors and novel markers like C-reactive protein (CRP) across different age groups is not well understood.
• Age-related changes in risk factor efficacy for CVD prediction require further investigation.

Purpose of the Study:

• To assess the discriminative ability of C-reactive protein (CRP) and the Framingham risk score for predicting cardiovascular disease (CVD) events in distinct age strata.
• To evaluate the incremental value of CRP in addition to conventional risk factors for CVD risk stratification across age groups.

Main Methods:

• Analysis of data from the Scottish Health Surveys (n=5,944) with an average follow-up of 7.1 years.
• Utilized Cox proportional hazards models and receiver operating characteristic (ROC) curves to assess predictive performance.
• Stratified analysis by age groups: young (35-50), middle (51-65), and older (>=65 years).

Main Results:

• The Framingham risk score demonstrated higher predictive accuracy for CVD events in younger (ROC 0.78) and middle-aged (ROC 0.72) participants compared to older adults (ROC 0.59).
• C-reactive protein (CRP) independently predicted CVD risk in middle-aged and older participants (HR 2.20 and 1.85, respectively) after adjusting for Framingham risk score.
• Adding CRP to the Framingham risk score model did not substantially improve CVD event prediction across any age group.

Conclusions:

• The predictive value of conventional risk factors for cardiovascular disease (CVD) diminishes with increasing age.
• C-reactive protein (CRP) has a limited additive role in stratifying CVD risk, particularly in older populations.
• The Framingham risk score algorithm is validated for primary care use in individuals under 65 years old.