C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis

sumber : http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-4Y0CXR9-1&_user=10&_coverDate=01%2F15%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=3915578ad09a876b45dbbf032a06eb88

The Emerging Risk Factors Collaboration‡

Available online 22 December 2009.


Refers to: C-reactive protein and cardiovascular risk: more fuel to the fire
The Lancet, Volume 375, Issue 9709, 9 January 2010-15 January 2010, Pages 95-96,
S Matthijs Boekholdt, John JP Kastelein
PDF (217 K)
Referred to by: C-reactive protein and cardiovascular risk: more fuel to the fire
The Lancet, Volume 375, Issue 9709, 9 January 2010-15 January 2010, Pages 95-96,
S Matthijs Boekholdt, John JP Kastelein
PDF (217 K)
Summary
Background

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.
Methods

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.
Results

Loge 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 loge 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.
Interpretation

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.
Funding

British Heart Foundation, UK Medical Research Council, BUPA Foundation, and GlaxoSmithKline.