The Value of C-Reactive Protein in Cardiovascular Risk Prediction

作者：Irene M. van der Meer, Moniek P.M. de Maat, Amanda J. Kiliaan, Deirdre A.M. van der Kuip, Albert Hofman, Jacqueline C.M. Witteman · 发表于：Archives of Internal Medicine · 年份：2003 · DOI：10.1001/archinte.163.11.1323 · 被引用次数：141 · 研究领域：Adipokines, Inflammation, and Metabolic Diseases、Lipoproteins and Cardiovascular Health、Cardiovascular Disease and Adiposity

BACKGROUND: Epidemiologic studies have shown that C-reactive protein (CRP) is a risk factor for coronary heart disease. Whether routine measurement of CRP has a role in the prediction of future coronary disease in everyday clinical practice has not yet been investigated. METHODS: Within the Rotterdam Study, a population-based cohort study of 7983 men and women 55 years and older, we conducted a nested case-control study to investigate the value of CRP in coronary disease prediction. Data are based on 157 participants who experienced a myocardial infarction during follow-up and 500 randomly selected controls. High-sensitivity CRP and traditional cardiovascular risk factors were measured at baseline. RESULTS: The age- and sex-adjusted relative risk of myocardial infarction for subjects in the highest quartile of the population distribution of CRP compared with the lowest quartile was 2.0 (95% confidence interval, 1.1-3.4). After additional adjustment for traditional cardiovascular risk factors, the increase in risk largely disappeared (odds ratio, 1.2; 95% confidence interval, 0.6-2.2). Adding CRP to a coronary disease risk function based on risk factors that are routinely assessed in clinical practice or to the Framingham risk function did not improve the area under the receiver operating characteristic curve of these risk functions. Sensitivity and specificity of both risk functions, computed after dichotomizing the estimated disease probabilities using prespecified cutoff po...