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Association of very highly elevated C-reactive protein concentration with cardiovascular events and all-cause
Mark Hamer1, Yoichi Chida, Emmanuel Stamatakis
1Department of Epidemiology and Public Health, University College London, London, UK. m.hamer@ucl.ac.uk
Insights
Very high high-sensitivity C-reactive protein (hsCRP) levels over 10 mg/L significantly predict cardiovascular disease (CVD) events and all-cause mortality. This elevated hsCRP offers meaningful prognostic information beyond conventional risk factors.
Area of Science:
- Cardiology
- Biomarkers
- Public Health
Background:
- The clinical significance of very high high-sensitivity C-reactive protein (hsCRP) concentrations (>10 mg/L) remains unclear.
- This study investigates the association between elevated hsCRP and the risk of cardiovascular disease (CVD) and mortality.
Purpose of the Study:
- To determine if very highly increased hsCRP levels predict incident CVD events and all-cause mortality.
- To assess the added prognostic value of hsCRP to conventional CVD risk models.
Main Methods:
- A cohort of 5248 participants without pre-existing CVD or infection was recruited from the Scottish Health Survey.
- Baseline measurements included hsCRP, conventional risk factors, and demographic data.
- Participants were followed for an average of 7 years for CVD events and all-cause mortality.
Main Results:
- Very highly increased hsCRP (>10 mg/L) was independently associated with a 2.40-fold increased risk of CVD events and a 3.64-fold increased risk of all-cause death.
- Adding hsCRP to the Framingham Risk Score reclassified 7.4% of participants into a higher CVD risk category.
- Elevated hsCRP correlated with modifiable risk factors like smoking, low HDL cholesterol, and central obesity.
Conclusions:
- hsCRP levels >10 mg/L are a stronger predictor of clinical events than the conventional threshold of 3 mg/L.
- Very high hsCRP concentrations provide clinically relevant prognostic information for cardiovascular events and mortality.
Background:
The clinical relevance of very highly increased high-sensitivity C-reactive protein (hsCRP) concentrations (>10 mg/L) is incompletely understood. We examined the association between very highly increased hsCRP and risk of incident cardiovascular disease (CVD) events and all-cause mortality.
Methods:
We recruited 5248 participants free from overt CVD and acute infection [mean age 53.5 (SD 12.4) years, 55.5% women] from the Scottish Health Survey, a representative sample of community-dwelling adults. hsCRP and other conventional risk factors were measured at baseline.
Results:
Over an average of 7 years' follow-up, there were a total of 259 incident CVD events (including myocardial infarction, coronary artery bypass, percutaneous coronary angioplasty, stroke, heart failure) and 357 all-cause deaths. Very highly increased hsCRP was associated with CVD events after adjustment for Framingham risk score (FRS), body mass index (BMI), central obesity, and hormone replacement therapy (HRT) (hazard ratio 2.40, 95% CI 1.51-3.81) and also with all-cause death (hazard ratio 3.64, 95% CI 2.57-5.15). With the addition of CRP scores to the conventional Framingham model, 7.4% of participants were reclassified into a high-risk (>20% FRS) CVD category. Very highly increased hsCRP was also associated with several modifiable risk factors, including smoking, HDL cholesterol, and central obesity.
Conclusions:
hsCRP >10 mg/L was a stronger predictor of clinical events than a conventional cut point of 3 mg/L. Very highly increased hsCRP may provide clinically meaningful prognostic information.
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