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Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Multiple Risk
L H Kuller1, R P Tracy, J Shaten
1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
Insights
C-reactive protein levels predict coronary heart disease mortality in high-risk individuals. Smokers with high C-reactive protein showed a significantly increased risk of death from coronary heart disease.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Epidemiology
Background:
- Acute phase proteins like C-reactive protein (CRP) are inflammatory markers.
- Their role in predicting cardiovascular events in high-risk populations requires further investigation.
Purpose of the Study:
- To assess the association between CRP, alpha 1 acid glycoprotein, albumin, and the risk of myocardial infarction (MI) and coronary heart disease (CHD) death.
- To investigate these associations in a prospective cohort of "healthy but high risk" individuals.
Main Methods:
- Nested case-control study within the Multiple Risk Factor Intervention Trial (MRFIT) cohort.
- Analysis included 98 MI cases, 148 CHD deaths, and 491 controls, followed for up to 17 years.
- Statistical models adjusted for smoking status, smoking cessation, and pulmonary function.
Main Results:
- A significant association was found between CRP levels and subsequent CHD mortality, particularly in smokers.
- Smokers in the highest CRP quartile had a 4.3-fold increased risk of CHD death compared to the lowest quartile.
- No significant association was observed for alpha 1 acid glycoprotein.
- Albumin showed an inverse relationship with CHD death only for events occurring 7-13 years post-baseline.
Conclusions:
- This prospective study provides the first evidence linking C-reactive protein to increased coronary heart disease mortality in "healthy but high risk" individuals.
- CRP may serve as a valuable prognostic biomarker for cardiovascular events in this population.
- Further research is warranted to elucidate the mechanisms underlying this association.
Abstract:
The authors measured the relation between C-reactive protein, alpha 1 acid glycoprotein and albumin, an acute phase protein, and subsequent risk of myocardial infarction and coronary heart disease death in a nested case-control study among the Multiple Risk Factor Intervention Trial (MRFIT) participants. There were 98 myocardial infarction cases, 148 coronary heart disease deaths, and 491 controls. The cases and controls were followed for up to 17 years for deaths and 6-7 years for myocardial infarction cases and controls. There was a significant association between available distribution of C-reactive protein and subsequent coronary heart disease mortality. For smokers at baseline, the risk of coronary heart disease deaths in quartile 4 of C-reactive protein as compared with quartile 1 was 4.3 (95% confidence interval 1.74-10.8). The association persisted when adjusted for characteristics related to smoking and smoking cessation during the trial and to pulmonary function. There was no relation between alpha 1 acid glycoprotein and either myocardial infarction or coronary heart disease death. Albumin was inversely related to coronary heart disease death only for deaths that occurred between 7 and 13 years after baseline, consistent with previous MRFIT analyses. This is the first prospective study in "healthy but high risk individuals" to document the relation between C-reactive protein and coronary heart disease mortality.