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C-Reactive Protein, Fibrinogen, and Cardiovascular Disease Prediction

Kaptoge, Stephen; Di Angelantonio, Emanuele; Pennells, Lisa; Wood, Angela M.; White, Ian R.; Gao, Pei; Walker, Matthew; Thompson, Alexander; Sarwar, Nadeem and Caslake, Muriel, et al. (2012) In New England Journal of Medicine 367(14). p.1310-1320
Abstract
Background There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. Methods We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen. Results The addition of information on high-density lipoprotein cholesterol to a prognostic model for... (More)
Background There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. Methods We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen. Results The addition of information on high-density lipoprotein cholesterol to a prognostic model for cardiovascular disease that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (P < 0.001), and yielded a net reclassification improvement of 1.52% and 0.83%, respectively, for the predicted 10-year risk categories of "low" (< 10%), " intermediate" (10% to < 20%), and "high" (>= 20%) (P < 0.02 for both comparisons). We estimated that among 100,000 adults 40 years of age or older, 15,025 persons would initially be classified as being at intermediate risk for a cardiovascular event if conventional risk factors alone were used to calculate risk. Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines (i.e., for persons with a predicted risk of >= 20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years. Conclusions In a study of people without known cardiovascular disease, we estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened. (Funded by the British Heart Foundation and others.) (Less)
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New England Journal of Medicine
volume
367
issue
14
pages
1310 - 1320
publisher
Massachusetts Medical Society
external identifiers
  • wos:000309406100007
  • scopus:84867164377
ISSN
0028-4793
DOI
10.1056/NEJMoa1107477
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English
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yes
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4bee141e-9247-4212-9733-5cc56ff5b221 (old id 3187317)
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2012-12-03 06:56:15
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2017-11-12 03:10:24
@article{4bee141e-9247-4212-9733-5cc56ff5b221,
  abstract     = {Background There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. Methods We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen. Results The addition of information on high-density lipoprotein cholesterol to a prognostic model for cardiovascular disease that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (P &lt; 0.001), and yielded a net reclassification improvement of 1.52% and 0.83%, respectively, for the predicted 10-year risk categories of "low" (&lt; 10%), " intermediate" (10% to &lt; 20%), and "high" (&gt;= 20%) (P &lt; 0.02 for both comparisons). We estimated that among 100,000 adults 40 years of age or older, 15,025 persons would initially be classified as being at intermediate risk for a cardiovascular event if conventional risk factors alone were used to calculate risk. Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines (i.e., for persons with a predicted risk of &gt;= 20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years. Conclusions In a study of people without known cardiovascular disease, we estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened. (Funded by the British Heart Foundation and others.)},
  author       = {Kaptoge, Stephen and Di Angelantonio, Emanuele and Pennells, Lisa and Wood, Angela M. and White, Ian R. and Gao, Pei and Walker, Matthew and Thompson, Alexander and Sarwar, Nadeem and Caslake, Muriel and Butterworth, Adam S. and Amouyel, Philippe and Assmann, Gerd and Bakker, Stephan J. L. and Barr, Elizabeth L. M. and Barrett-Connor, Elizabeth and Benjamin, Emelia J. and Bjorkelund, Cecilia and Brenner, Hermann and Brunner, Eric and Clarke, Robert and Cooper, Jackie A. and Cremer, Peter and Cushman, Mary and Dagenais, Gilles R. and D'Agostino, Ralph B. and Dankner, Rachel and Davey-Smith, George and Deeg, Dorly and Dekker, Jacqueline M. and Engström, Gunnar and Folsom, Aaron R. and Fowkes, F. Gerry R. and Gallacher, John and Gaziano, J. Michael and Giampaoli, Simona and Gillum, Richard F. and Hofman, Albert and Howard, Barbara V. and Ingelsson, Erik and Iso, Hiroyasu and Jorgensen, Torben and Kiechl, Stefan and Kitamura, Akihiko and Kiyohara, Yutaka and Koenig, Wolfgang and Kromhout, Daan and Kuller, Lewis H. and Lawlor, Debbie A. and Meade, Tom W. and Nissinen, Aulikki and Nordestgaard, Borge G. and Onat, Altan and Panagiotakos, Demosthenes B. and Psaty, Bruce M. and Rodriguez, Beatriz and Rosengren, Annika and Salomaa, Veikko and Kauhanen, Jussi and Salonen, Jukka T. and Shaffer, Jonathan A. and Shea, Steven and Ford, Ian and Stehouwer, Coen D. A. and Strandberg, Timo E. and Tipping, Robert W. and Tosetto, Alberto and Wassertheil-Smoller, Sylvia and Wennberg, Patrik and Westendorp, Rudi G. and Whincup, Peter H. and Wilhelmsen, Lars and Woodward, Mark and Lowe, Gordon D. O. and Wareham, Nicholas J. and Khaw, Kay-Tee and Sattar, Naveed and Packard, Chris J. and Gudnason, Vilmundur and Ridker, Paul M. and Pepys, Mark B. and Thompson, Simon G. and Danesh, John},
  issn         = {0028-4793},
  language     = {eng},
  number       = {14},
  pages        = {1310--1320},
  publisher    = {Massachusetts Medical Society},
  series       = {New England Journal of Medicine},
  title        = {C-Reactive Protein, Fibrinogen, and Cardiovascular Disease Prediction},
  url          = {http://dx.doi.org/10.1056/NEJMoa1107477},
  volume       = {367},
  year         = {2012},
}