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C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis.
Tuesday,2012-11-06 12:19 America/Los_Angeles — eenright
| Title | C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. |
| Publication Type | Journal Article |
| Year of Publication | 2010 |
| Authors | Kaptoge, S, Di Angelantonio, E, Lowe, G, Pepys, MB, Thompson, SG, Collins, R, Danesh, J |
| Corporate/Institutional Authors | Emerging Risk Factors Collaboration, |
| Journal | Lancet |
| Volume | 375 |
| Issue | 9709 |
| Pagination | 132-40 |
| Date Published | 2010 Jan 09 |
| ISSN | 1474-547X |
| Keywords | Alcohol Drinking, Biomarkers, Blood Pressure, Body Mass Index, C-Reactive Protein, Cholesterol, Coronary Disease, Databases, Factual, Diabetes Mellitus, Female, Fibrinogen, Humans, Interleukin-6, Leukocyte Count, Lung Diseases, Male, Middle Aged, Motor Activity, Neoplasms, Regression Analysis, Risk Assessment, Risk Factors, Serum Albumin, Sex Factors, Smoking, Stroke, Triglycerides |
| Abstract | <p><b>BACKGROUND: </b>Associations of C-reactive protein (CRP) concentration with risk of major diseases can best be assessed by long-term prospective follow-up of large numbers of people. We assessed the associations of CRP concentration with risk of vascular and non-vascular outcomes under different circumstances.</p><p><b>METHODS: </b>We meta-analysed individual records of 160 309 people without a history of vascular disease (ie, 1.31 million person-years at risk, 27 769 fatal or non-fatal disease outcomes) from 54 long-term prospective studies. Within-study regression analyses were adjusted for within-person variation in risk factor levels.</p><p><b>RESULTS: </b>Log(e) CRP concentration was linearly associated with several conventional risk factors and inflammatory markers, and nearly log-linearly with the risk of ischaemic vascular disease and non-vascular mortality. Risk ratios (RRs) for coronary heart disease per 1-SD higher log(e) CRP concentration (three-fold higher) were 1.63 (95% CI 1.51-1.76) when initially adjusted for age and sex only, and 1.37 (1.27-1.48) when adjusted further for conventional risk factors; 1.44 (1.32-1.57) and 1.27 (1.15-1.40) for ischaemic stroke; 1.71 (1.53-1.91) and 1.55 (1.37-1.76) for vascular mortality; and 1.55 (1.41-1.69) and 1.54 (1.40-1.68) for non-vascular mortality. RRs were largely unchanged after exclusion of smokers or initial follow-up. After further adjustment for fibrinogen, the corresponding RRs were 1.23 (1.07-1.42) for coronary heart disease; 1.32 (1.18-1.49) for ischaemic stroke; 1.34 (1.18-1.52) for vascular mortality; and 1.34 (1.20-1.50) for non-vascular mortality.</p><p><b>INTERPRETATION: </b>CRP concentration has continuous associations with the risk of coronary heart disease, ischaemic stroke, vascular mortality, and death from several cancers and lung disease that are each of broadly similar size. The relevance of CRP to such a range of disorders is unclear. Associations with ischaemic vascular disease depend considerably on conventional risk factors and other markers of inflammation.</p><p><b>FUNDING: </b>British Heart Foundation, UK Medical Research Council, BUPA Foundation, and GlaxoSmithKline.</p> |
| DOI | 10.1016/S0140-6736(09)61717-7 |
| Alternate Journal | Lancet |
| PubMed ID | 20031199 |
| PubMed Central ID | PMC3162187 |
| Grant List | / / British Heart Foundation / United Kingdom G0600705 / / Medical Research Council / United Kingdom PG/09/002/26056 / / British Heart Foundation / United Kingdom RG/08/014/24067 / / British Heart Foundation / United Kingdom / / Medical Research Council / United Kingdom RG/08/013/25942 / / British Heart Foundation / United Kingdom MC_U137686857 / / Medical Research Council / United Kingdom G0401527 / / Medical Research Council / United Kingdom UL1 RR029882 / RR / NCRR NIH HHS / United States G7900510 / / Medical Research Council / United Kingdom MC_U105260792 / / Medical Research Council / United Kingdom |