C-reactive protein, fibrinogen, and cardiovascular disease prediction.
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Emerging Risk Factors Collaboration, Kaptoge Stephen, Di Angelantonio Emanuele, Pennells Lisa, Wood Angela M, White Ian R, Gao Pei, Walker Matthew, Thompson Alexander, Sarwar Nadeem, Caslake Muriel, Butterworth Adam S, Amouyel Philippe, Assmann Gerd, Bakker Stephan J L, Barr Elizabeth L M, Barrett-Connor Elizabeth, Benjamin Emelia J, Björkelund Cecilia, Brenner Hermann, Brunner Eric, Clarke Robert, Cooper Jackie A, Cremer Peter, Cushman Mary, Dagenais Gilles R, D'Agostino Ralph B, Dankner Rachel, Davey-Smith George, Deeg Dorly, Dekker Jacqueline M, Engström Gunnar, Folsom Aaron R, Fowkes F Gerry R, Gallacher John, Gaziano J Michael, Giampaoli Simona, Gillum Richard F, Hofman Albert, Howard Barbara V, Ingelsson Erik, Iso Hiroyasu, Jørgensen Torben, Kiechl Stefan, Kitamura Akihiko, Kiyohara Yutaka, Koenig Wolfgang, Kromhout Daan, Kuller Lewis H, Lawlor Debbie A, Meade Tom W, Nissinen Aulikki, Nordestgaard Børge G, Onat Altan, Panagiotakos Demosthenes B, Psaty Bruce M, Rodriguez Beatriz, Rosengren Annika, Salomaa Veikko, Kauhanen Jussi, Salonen Jukka T, Shaffer Jonathan A, Shea Steven, Ford Ian, Stehouwer Coen D A, Strandberg Timo E, Tipping Robert W, Tosetto Alberto, Wassertheil-Smoller Sylvia, Wennberg Patrik, Westendorp Rudi G, Whincup Peter H, Wilhelmsen Lars, Woodward Mark, Lowe Gordon D O, Wareham Nicholas J, Khaw Kay-Tee, Sattar Naveed, Packard Chris J, Gudnason Vilmundur, Ridker Paul M, Pepys Mark B, Thompson Simon G, Danesh John
Аннотация
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.).