Clinical Investigations: Acute Ischemic Heart DiseaseC-reactive protein and incident coronary heart disease in the Atherosclerosis Risk In Communities (ARIC) study☆,☆☆,★
Section snippets
Study population and baseline measurements
In 1987 through 1989, the ARIC Study24 recruited a population-based cohort of 15,792 persons aged 45 to 64 years from 4 US communities. ARIC reexamined participants in 1990 to 1992 (93% return rate), 1993 to 1995 (86% return), and 1995 to 1997 (80% return).
Technicians measured resting blood pressure 3 times with a random-zero sphygmomanometer and averaged the last 2 measurements for analysis. We expressed physical activity as a sport index ranging from 0 (low) to 5 (high).25 Trained technicians
Relations of CRP with other risk factors
C-reactive protein values at visit 1 were higher in women than in men, higher in African-Americans than in whites, and higher in diabetic subjects than in nondiabetic subjects (Table I).Empty Cell CRP quintiles (mg/L) Variable <0.83 0.83-2.07 2.08-3.85 3.86-6.09 >6.09 P† No. 118 118 118 118 118 Age (y) 55.8 55.3 56.2 57.7 57.5 <.001 Sex (% male) 66.4 67.8 57.7 52.0 43.4 .002 Race (% African-American)
Discussion
The main finding of this prospective study was that higher blood levels of CRP in middle-aged adults were moderately strongly associated with increased incidence of CHD. The association was weakened but still significant after adjustment for traditional risk factors. Adjustment for other inflammatory markers (fibrinogen, WBC count, and ICAM-1), not unexpectedly, weakened the association further. CRP was not independently associated with prevalent carotid atherosclerosis.
A recent meta analysis1
References (44)
- et al.
Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly
Am J Med
(1999) - et al.
A short questionnaire for the measurement of habitual physical activity in epidemiological studies
Am J Clin Nutr
(1982) - et al.
Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience
J Clin Epidemiol
(1996) - et al.
Association of C-reactive protein with markers of prevalent atherosclerotic disease (the NHLBI Family Heart Study)
Am J Cardiol
(2001) - et al.
Lack of association of C-reactive protein and coronary calcium by electron beam computed tomography in postmenopausal women: implications for coronary artery disease screening
J Am Coll Cardiol
(2000) - et al.
C-reactive protein is not associated with the presence or extent of calcified subclinical atherosclerosis
Am Heart J
(2001) - et al.
Low grade inflammation and coronary heart disease: prospective study and updated meta-analysis
BMJ
(2000) - et al.
C-reactive protein as a cardiovascular risk factor: more than an epiphen-omenon?
Circulation
(1999) - et al.
Interferon-γ and lipopolysaccharide potentiate monocyte tissue factor induction by C-reactive protein: relationship with age, sex, and hormone replacement treatment
Circulation
(2000) - et al.
C-reactive protein-mediated low density lipoprotein uptake by macrophages: implications for atherosclerosis
Circulation
(2001)
Direct proinflammatory effect of C-reactive protein on human endothelial cells
Circulation
Elevated C-reactive protein levels and impaired endothelial vasoreactivity in patients with coronary artery disease
Circulation
Prospective study of hemostatic factors and incidence of coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study
Circulation
Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies
JAMA
Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men
Circulation
Elevation of tumor necrosis factor-γ and increased risk of recurrent coronary events after myocardial infarction
Circulation
Lipoprotein-associated phospholipase A2 as an independent predictor of coronary heart disease
N Engl J Med
Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study: Multiple Risk Factor Intervention Trial
Am J Epidemiol
Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men
N Engl J Med
Relationship of C-reactive protein to risk of cardiovascular disease in the elderly: Results from the Cardiovascular Health Study and the Rural Health Promotion Project
Arterioscler Thromb Vasc Biol
C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992
Circulation
von Willebrand factor, C-reactive protein, and 5-year mortality in diabetic and nondiabetic subjects: the Hoorn Study
Arterioscler Thromb Vasc Biol
Cited by (200)
A systematic review and meta-analysis of the stability of peripheral immune markers in healthy adults
2023, Brain, Behavior, and ImmunityInduction of decay accelerating factor and membrane cofactor protein by resveratrol attenuates complement deposition in human coronary artery endothelial cells
2019, Biochemistry and Biophysics ReportsNeutrophil-to-lymphocyte ratio is associated with diabetic peripheral neuropathy in type 2 diabetes patients
2017, Diabetes Research and Clinical PracticeReply to: Is physical activity really associated with reduced odds of elevated red cell distribution width?
2017, International Journal of CardiologyC-reactive Protein Level, Apolipoprotein B-to-apolipoprotein A-1 Ratio, and Risks of Ischemic Stroke and Coronary Heart Disease among Inner Mongolians in China
2016, Biomedical and Environmental Sciences
- ☆
Supported by contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022 from the United States National Heart, Lung, and Blood Institute.
- ☆☆
Reprint requests: Aaron R. Folsom, MD, Division of Epidemiology, School of Public Health, University of Minnesota, Suite 300, 1300 S Second St, Minneapolis, MN 55454-1015.
- ★
E-mail: [email protected]