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C-reactive protein, fibrinogen, and cardiovascular disease prediction.

, Stephen Kaptoge, Emanuele Di Angelantonio

    The New England Journal of Medicine
    |October 5, 2012

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  • Biomedical And Clinical Sciences
  • Oncology And Carcinogenesis
  • Predictive And Prognostic Markers
  • C-reactive Protein, Fibrinogen, And Cardiovascular Disease Prediction.

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    View abstract on PubMed

    Summary
    This summary is machine-generated.

    Assessing C-reactive protein (CRP) and fibrinogen levels improves cardiovascular event prediction in intermediate-risk individuals. This can help prevent cardiovascular events with targeted statin therapy.

    Area of Science:

    • Cardiology
    • Biomarkers
    • Preventive Medicine

    Background:

    • Debate exists regarding the utility of inflammatory biomarkers like C-reactive protein (CRP) for predicting initial cardiovascular events.
    • Conventional risk factors are established, but their predictive power for first-time cardiovascular events has limitations.

    Purpose of the Study:

    • To evaluate the added value of C-reactive protein (CRP) and fibrinogen levels to conventional risk factors in predicting cardiovascular risk.
    • To model the clinical impact of initiating statin therapy based on CRP or fibrinogen assessment.

    Main Methods:

    • Analysis of data from 52 prospective studies with 246,669 participants without prior cardiovascular disease.
    • Calculation of discrimination and reclassification measures, and modeling of clinical implications for statin initiation.

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    Main Results:

    • Adding high-density lipoprotein cholesterol improved risk discrimination (C-index increase of 0.0050).
    • Further addition of CRP or fibrinogen increased the C-index (0.0039 and 0.0027, respectively) and improved risk reclassification by 1.52% and 0.83%.
    • Targeted assessment in intermediate-risk individuals could prevent approximately 30 cardiovascular events per 100,000 adults over 10 years.

    Conclusions:

    • Assessing CRP or fibrinogen levels in individuals at intermediate cardiovascular risk can aid in preventing cardiovascular events.
    • Screening 400-500 intermediate-risk individuals may prevent one additional cardiovascular event over 10 years under current treatment guidelines.