Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17:1121-1127
© 1997 American Heart Association, Inc.
Articles |
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
From the University of Vermont (R.P.T., M.C.), Colchester; Cardiovascular Health Research Unit (R.N.L., B.M.P.), University of Washington, Seattle; and the University of Pittsburgh (Pa) (D.G.I., R.W.E., E.N.M., L.H.K.).
Correspondence to Dr Russell Tracy, University of Vermont, Aquatec Bldg, 55A S Park Dr, Colchester, VT 05446. E-mail rtracy{at}moose.uvm.edu
Abstract Markers of inflammation, such as C-reactive protein (CRP), are related to risk of cardiovascular disease (CVD) events in those with angina, but little is known about individuals without prevalent clinical CVD. We performed a prospective, nested case-control study in the Cardiovascular Health Study (CHS; 5201 healthy elderly men and women). Case subjects (n=146 men and women with incident CVD events including angina, myocardial infarction, and death) and control subjects (n=146) were matched on the basis of sex and the presence or absence of significant subclinical CVD at baseline (average follow-up, 2.4 years). In women but not men, the mean CRP level was higher for case subjects than for control subjects (P
.05). In general, CRP was higher in those with subclinical disease. Most of the association of CRP with female case subjects versus control subjects was in the subgroup with subclinical disease: 3.33 versus 1.90 mg/L, P<.05, adjusted for age and time of follow-up. Case-control differences were greatest when the time between baseline and the CVD event was shortest. The strongest associations were with myocardial infarction, and there was an overall odds ratio for incident myocardial infarction for men and women with subclinical disease (upper quartile versus lower three quartiles) of 2.67 (confidence interval [CI]=1.04 to 6.81), with the relationship being stronger in women (4.50 [CI=0.97 to 20.8]) than in men (1.75 [CI=0.51 to 5.98]). We performed a similar study in the Rural Health Promotion Project, in which mean values of CRP were higher for female case subjects than for female control subjects, but no differences were apparent for men. Comparing the upper quintile with the lower four, the odds ratio for CVD case subjects was 2.7 (CI=1.10 to 6.60). In conclusion, CRP was associated with incident events in the elderly, especially in those with subclinical disease at baseline.
Key Words: clotting • inflammation • coronary heart disease • C-reactive protein
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 D.J. Brull, N. Serrano, F. Zito, L. Jones, H.E. Montgomery, A. Rumley, P. Sharma, G.D.O. Lowe, M.J. World, S.E. Humphries, et al. Human CRP Gene Polymorphism Influences CRP Levels: Implications for the Prediction and Pathogenesis of Coronary Heart Disease Arterioscler Thromb Vasc Biol, November 1, 2003; 23(11): 2063 - 2069. [Abstract] [Full Text] [PDF]
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A. B. Newman, A. M. Arnold, B. L. Naydeck, L. P. Fried, G. L. Burke, P. Enright, J. Gottdiener, C. Hirsch, D. O'Leary, and R. Tracy "Successful Aging": Effect of Subclinical Cardiovascular Disease Arch Intern Med, October 27, 2003; 163(19): 2315 - 2322. [Abstract] [Full Text] [PDF]
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 P Jousilahti, V Salomaa, V Rasi, E Vahtera, and T Palosuo Association of markers of systemic inflammation, C reactive protein, serum amyloid A, and fibrinogen, with socioeconomic status J Epidemiol Community Health, September 1, 2003; 57(9): 730 - 733. [Abstract] [Full Text] [PDF]
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P. Holvoet, T. B. Harris, R. P. Tracy, P. Verhamme, A. B. Newman, S. M. Rubin, E. M. Simonsick, L. H. Colbert, and S. B. Kritchevsky Association of High Coronary Heart Disease Risk Status With Circulating Oxidized LDL in the Well-Functioning Elderly: Findings From the Health, Aging, and Body Composition Study Arterioscler Thromb Vasc Biol, August 1, 2003; 23(8): 1444 - 1448. [Abstract] [Full Text] [PDF]
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J. J. Cao, C. Thach, T. A. Manolio, B. M. Psaty, L. H. Kuller, P. H.M. Chaves, J. F. Polak, K. Sutton-Tyrrell, D. M. Herrington, T. R. Price, et al. C-Reactive Protein, Carotid Intima-Media Thickness, and Incidence of Ischemic Stroke in the Elderly: The Cardiovascular Health Study Circulation, July 15, 2003; 108(2): 166 - 170. [Abstract] [Full Text] [PDF]
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G. Luc, J.-M. Bard, I. Juhan-Vague, J. Ferrieres, A. Evans, P. Amouyel, D. Arveiler, J.-C. Fruchart, and P. Ducimetiere C-Reactive Protein, Interleukin-6, and Fibrinogen as Predictors of Coronary Heart Disease: The PRIME Study Arterioscler Thromb Vasc Biol, July 1, 2003; 23(7): 1255 - 1261. [Abstract] [Full Text] [PDF]
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I. M. van der Meer, M. P. M. de Maat, A. J. Kiliaan, D. A. M. van der Kuip, A. Hofman, and J. C. M. Witteman The Value of C-Reactive Protein in Cardiovascular Risk Prediction: The Rotterdam Study Arch Intern Med, June 9, 2003; 163(11): 1323 - 1328. [Abstract] [Full Text] [PDF]
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G. D. Slade, E. M. Ghezzi, G. Heiss, J. D. Beck, E. Riche, and S. Offenbacher Relationship Between Periodontal Disease and C-Reactive Protein Among Adults in the Atherosclerosis Risk in Communities Study Arch Intern Med, May 26, 2003; 163(10): 1172 - 1179. [Abstract] [Full Text] [PDF]
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 J. Cosin-Sales, C. Pizzi, S. Brown, and J. C. Kaski C-reactive protein, clinical presentation, and ischemic activity in patients with chest pain and normal coronary angiograms J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1468 - 1474. [Abstract] [Full Text] [PDF]
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M. Danner, S. V. Kasl, J. L. Abramson, and V. Vaccarino Association Between Depression and Elevated C-Reactive Protein Psychosom Med, May 1, 2003; 65(3): 347 - 356. [Abstract] [Full Text] [PDF]
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J. D. Curb, R. D. Abbott, B. L. Rodriguez, P. Sakkinen, J. S. Popper, K. Yano, and R. P. Tracy C-Reactive Protein and the Future Risk of Thromboembolic Stroke in Healthy Men Circulation, April 22, 2003; 107(15): 2016 - 2020. [Abstract] [Full Text] [PDF]
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L. F. Fried, M. G. Shlipak, C. Crump, A. J. Bleyer, J. S. Gottdiener, R. A. Kronmal, L. H. Kuller, and A. B. Newman Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1364 - 1372. [Abstract] [Full Text] [PDF]
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E. S. Ford, W. H. Giles, G. L. Myers, and D. M. Mannino Population Distribution of High-Sensitivity C-reactive Protein among US Men: Findings from National Health and Nutrition Examination Survey 1999-2000 Clin. Chem., April 1, 2003; 49(4): 686 - 690. [Full Text] [PDF]
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A. D. Pradhan, N. R. Cook, J. E. Buring, J. E. Manson, and P. M. Ridker C-Reactive Protein Is Independently Associated With Fasting Insulin in Nondiabetic Women Arterioscler Thromb Vasc Biol, April 1, 2003; 23(4): 650 - 655. [Abstract] [Full Text] [PDF]
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T. H. Schindler, B. Hornig, P. T. Buser, M. Olschewski, N. Magosaki, M. Pfisterer, E. U. Nitzsche, U. Solzbach, and H. Just Prognostic Value of Abnormal Vasoreactivity of Epicardial Coronary Arteries to Sympathetic Stimulation in Patients With Normal Coronary Angiograms Arterioscler Thromb Vasc Biol, March 1, 2003; 23(3): 495 - 501. [Abstract] [Full Text] [PDF]
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G. J. Blake and P. M. Ridker C-reactive protein and other inflammatory risk markers in acute coronary syndromes J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 37S - 42S. [Abstract] [Full Text] [PDF]
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 P. L. Enright, M. A. McBurnie, V. Bittner, R. P. Tracy, R. McNamara, A. Arnold, and A. B. Newman The 6-min Walk Test: A Quick Measure of Functional Status in Elderly Adults Chest, February 1, 2003; 123(2): 387 - 398. [Abstract] [Full Text] [PDF]
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 M. A. Zimmerman, C. H. Selzman, C. Cothren, A. C. Sorensen, C. D. Raeburn, and A. H. Harken Diagnostic Implications of C-Reactive Protein Arch Surg, February 1, 2003; 138(2): 220 - 224. [Abstract] [Full Text] [PDF]
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P. M Ridker Clinical Application of C-Reactive Protein for Cardiovascular Disease Detection and Prevention Circulation, January 28, 2003; 107(3): 363 - 369. [Full Text] [PDF]
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T. A. Pearson, G. A. Mensah, R. W. Alexander, J. L. Anderson, R. O. Cannon III, M. Criqui, Y. Y. Fadl, S. P. Fortmann, Y. Hong, G. L. Myers, et al. Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association Circulation, January 28, 2003; 107(3): 499 - 511. [Full Text] [PDF]
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P. M Ridker, J. E. Buring, N. R. Cook, and N. Rifai C-Reactive Protein, the Metabolic Syndrome, and Risk of Incident Cardiovascular Events: An 8-Year Follow-Up of 14 719 Initially Healthy American Women Circulation, January 28, 2003; 107(3): 391 - 397. [Abstract] [Full Text] [PDF]
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M. S. Beattie, M. G. Shlipak, H. Liu, W. S. Browner, N. B. Schiller, and M. A. Whooley C-Reactive Protein and Ischemia in Users and Nonusers of {beta}-Blockers and Statins: Data From the Heart and Soul Study Circulation, January 21, 2003; 107(2): 245 - 250. [Abstract] [Full Text] [PDF]
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B. Thorand, H. Lowel, A. Schneider, H. Kolb, C. Meisinger, M. Frohlich, and W. Koenig C-Reactive Protein as a Predictor for Incident Diabetes Mellitus Among Middle-aged Men: Results From the MONICA Augsburg Cohort Study, 1984-1998 Arch Intern Med, January 13, 2003; 163(1): 93 - 99. [Abstract] [Full Text] [PDF]
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M. G. Shlipak, L. F. Fried, C. Crump, A. J. Bleyer, T. A. Manolio, R. P. Tracy, C. D. Furberg, and B. M. Psaty Elevations of Inflammatory and Procoagulant Biomarkers in Elderly Persons With Renal Insufficiency Circulation, January 7, 2003; 107(1): 87 - 92. [Abstract] [Full Text] [PDF]
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R. A. Hegele, M. E. Kraw, M. R. Ban, B. A. Miskie, M. W. Huff, and H. Cao Elevated Serum C-Reactive Protein and Free Fatty Acids Among Nondiabetic Carriers of Missense Mutations in the Gene Encoding Lamin A/C (LMNA) With Partial Lipodystrophy Arterioscler Thromb Vasc Biol, January 1, 2003; 23(1): 111 - 116. [Abstract] [Full Text] [PDF]
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References Circulation, December 17, 2002; 106(25): 3373 - 3421. [Full Text]
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L. Djousse, K. J. Rothman, L. A. Cupples, D. Levy, and R. C. Ellison Serum Albumin and Risk of Myocardial Infarction and All-Cause Mortality in the Framingham Offspring Study Circulation, December 3, 2002; 106(23): 2919 - 2924. [Abstract] [Full Text] [PDF]
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 P. Greenland, S. S Gidding, and R. P Tracy Commentary: Lifelong prevention of atherosclerosis: the critical importance of major risk factor exposures Int. J. Epidemiol., December 1, 2002; 31(6): 1129 - 1134. [Full Text]
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N. S. Jenny, R. P. Tracy, M. S. Ogg, L. A. Luong, L. H. Kuller, A. M. Arnold, A. R. Sharrett, and S. E. Humphries In the Elderly, Interleukin-6 Plasma Levels and the -174G>C Polymorphism Are Associated With the Development of Cardiovascular Disease Arterioscler Thromb Vasc Biol, December 1, 2002; 22(12): 2066 - 2071. [Abstract] [Full Text] [PDF]
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