European Heart Journal Advance Access originally published online on April 8, 2005
European Heart Journal 2005 26(17):1783-1789; doi:10.1093/eurheartj/ehi237
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study
1Department of Medicine, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland
2Department of Physiology, University of Kuopio, Kuopio, Finland
3Research Institute of Public Health, University of Kuopio, Kuopio, Finland
4Department of Clinical Chemistry, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland
5Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland
6Oy Jurilab Ltd, Kuopio, Finland
Received 17 October 2004; revised 13 February 2005; accepted 23 February 2005; online publish-ahead-of-print 8 April 2005.
* Corresponding author. Tel: +358 17 173 311; fax: +358 17 163 112. E-mail address: david.laaksonen{at}uku.fi
Aims Cut-offs for C-reactive protein concentrations have been recommended for risk stratification, but little is known about how these cut-offs predict cardiovascular risk in population-based cohorts. We therefore assessed the association of C-reactive protein levels with cardiovascular mortality in a population-based cohort of 2321 middle-aged men stratified by the presence of cardiovascular disease (CVD) at baseline.
Methods and results C-reactive protein concentrations were categorized according to current recommendations (1 and 3 mg/L). During the 15 year follow-up, 77 men without CVD and 121 men with CVD at baseline died of CVD. In men without CVD at baseline (n=1476), age-adjusted cardiovascular mortality was 4.1-fold higher (95% CI 2.1–8.2) for C-reactive protein levels between 3.0 and 9.9 mg/L at baseline than for C-reactive protein levels <1.0 mg/L. In men with CVD at baseline (n=845), the corresponding age-adjusted cardiovascular mortality was 3.3-fold higher (95% CI 2.0–5.3). Adjustment for conventional CVD risk factors attenuated the risk somewhat. Further adjustment for dietary and lifestyle factors and factors related to insulin resistance did not affect the association. Classification of C-reactive protein by tertiles gave qualitatively similar results, but identified twice as many men at high risk. C-reactive protein levels also predicted overall mortality.
Conclusion Currently, recommended cut-offs for C-reactive protein levels identify men at risk for cardiovascular and overall death independently of conventional and other risk factors in a population-based sample of middle-aged men with and without CVD at baseline. Lower cut-offs may better identify men at high risk for cardiovascular death, but improvement of current recommendations will require standardization of C-reactive protein assays.
Key Words: Inflammation • C-reactive protein • Cardiovascular disease • Risk factors • Mortality • Cohort study
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. E. Laaksonen, L. Niskanen, K. Nyyssonen, T. A. Lakka, J. A. Laukkanen, and J. T. Salonen Dyslipidaemia as a predictor of hypertension in middle-aged men Eur. Heart J., October 2, 2008; 29(20): 2561 - 2568. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Kallio, M. Kolehmainen, D. E Laaksonen, L. Pulkkinen, M. Atalay, H. Mykkanen, M. Uusitupa, K. Poutanen, and L. Niskanen Inflammation markers are modulated by responses to diets differing in postprandial insulin responses in individuals with the metabolic syndrome Am. J. Clinical Nutrition, May 1, 2008; 87(5): 1497 - 1503. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Clarke, J. R. Emberson, E. Breeze, J. P. Casas, S. Parish, A. D. Hingorani, A. Fletcher, R. Collins, and L. Smeeth Biomarkers of inflammation predict both vascular and non-vascular mortality in older men Eur. Heart J., March 2, 2008; 29(6): 800 - 809. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M Ridker High-Sensitivity C-Reactive Protein as a Predictor of All-Cause Mortality: Implications for Research and Patient Care Clin. Chem., February 1, 2008; 54(2): 234 - 237. [Full Text] [PDF]
|
|
|
|
|
|
W. Koenig, N. Khuseyinova, J. Baumert, and C. Meisinger Prospective Study of High-Sensitivity C-Reactive Protein as a Determinant of Mortality: Results from the MONICA/KORA Augsburg Cohort Study, 1984-1998 Clin. Chem., February 1, 2008; 54(2): 335 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Ridker C-Reactive Protein and the Prediction of Cardiovascular Events Among Those at Intermediate Risk: Moving an Inflammatory Hypothesis Toward Consensus J. Am. Coll. Cardiol., May 29, 2007; 49(21): 2129 - 2138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Libby and P. M. Ridker Inflammation and Atherothrombosis: From Population Biology and Bench Research to Clinical Practice J. Am. Coll. Cardiol., October 27, 2006; 48(9_Suppl_A): A33 - A46. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Albert and P. M Ridker C-Reactive Protein as a Risk Predictor: Do Race/Ethnicity and Gender Make a Difference? Circulation, August 1, 2006; 114(5): e67 - e74. [Full Text] [PDF]
|
|
|
|
 |
|
 N. R. Cook, J. E. Buring, and P. M Ridker The Effect of Including C-Reactive Protein in Cardiovascular Risk Prediction Models for Women Ann Intern Med, July 4, 2006; 145(1): 21 - 29. [Abstract] [Full Text] [PDF]
|
|