European Heart Journal Advance Access originally published online on November 28, 2006
European Heart Journal 2006 27(24):2962-2968; doi:10.1093/eurheartj/ehl362
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Impact of C-reactive protein and fibrinogen on cardiovascular prognosis in patients with stable angina pectoris: the AtheroGene study
1 Department of Medicine, Bundeswehrzentralkrankenhaus Koblenz, Germany
2 Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg-University Mainz, Germany
3 Department of Medicine II, Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
4 Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg-University Mainz, Germany
5 INSERM U525, Faculté de Médicine Pitié-Salpétrière Paris, France
Received 17 May 2006; revised 14 October 2006; accepted 20 October 2006; online publish-ahead-of-print 28 November 2006.
* Corresponding author. Tel: +49 6131 175169; fax: +49 6131 175691. E-mail address: blankenberg{at}2-med.klinik.uni-mainz.de
Aims C-reactive protein and fibrinogen have been extensively studied and shown to be predictive for a first cardiovascular event in healthy individuals. We evaluated the potential clinical use of C-reactive protein and fibrinogen in patients already suffering from coronary artery disease (CAD).
Methods and results In a substudy of the prospective AtheroGene registry, we assessed in 1806 patients with documented CAD and stable angina pectoris, the risk of cardiovascular death and non-fatal myocardial infarction (n=183) over a median follow-up of 3.5 (maximum 7.7) years according to baseline levels of C-reactive protein and fibrinogen.
C-reactive protein and fibrinogen were associated with future cardiovascular events, such as an increment in one standard deviation of C-reactive protein is associated with a 1.15-fold (95% CI 1.05–1.27, P=0.002) increase, an increment of one standard deviation of fibrinogen with a 1.27-fold (95% CI 1.12–1.43, P<0.0005) increase in hazard risk in the models adjusted for age and sex. Adjustment for traditional risk factors and clinical confounders did not significantly attenuate this relationship. In a comparison of a basic model (traditional risk factors; AUC=0.68) with models additionally including either C-reactive protein (AUC=0.69) or fibrinogen (AUC=0.70), only little additional predictive information over that obtained from assessment of traditional risk factors was obtained.
Conclusion In patients with documented CAD, C-reactive protein and fibrinogen were predictive for future cardiovascular risk, but did not provide further information on top of that obtained from models including traditional risk factors. Our data emphasize the clinical importance of traditional risk factors in patients with CAD.
Key Words: C-reactive protein • Fibrinogen • Coronary artery disease • Stable angina pectoris • Risk factors • Prognosis
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