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C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study.
Eur Heart J. 2005 Sep; 26(17):1783-9.EH

Abstract

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.

Authors+Show Affiliations

Department of Medicine, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland. david.laaksonen@uku.fiNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15821003

Citation

Laaksonen, David E., et al. "C-reactive Protein in the Prediction of Cardiovascular and Overall Mortality in Middle-aged Men: a Population-based Cohort Study." European Heart Journal, vol. 26, no. 17, 2005, pp. 1783-9.
Laaksonen DE, Niskanen L, Nyyssönen K, et al. C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study. Eur Heart J. 2005;26(17):1783-9.
Laaksonen, D. E., Niskanen, L., Nyyssönen, K., Punnonen, K., Tuomainen, T. P., & Salonen, J. T. (2005). C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study. European Heart Journal, 26(17), 1783-9.
Laaksonen DE, et al. C-reactive Protein in the Prediction of Cardiovascular and Overall Mortality in Middle-aged Men: a Population-based Cohort Study. Eur Heart J. 2005;26(17):1783-9. PubMed PMID: 15821003.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study. AU - Laaksonen,David E, AU - Niskanen,Leo, AU - Nyyssönen,Kristiina, AU - Punnonen,Kari, AU - Tuomainen,Tomi-Pekka, AU - Salonen,Jukka T, Y1 - 2005/04/08/ PY - 2005/4/12/pubmed PY - 2006/2/9/medline PY - 2005/4/12/entrez SP - 1783 EP - 9 JF - European heart journal JO - Eur. Heart J. VL - 26 IS - 17 N2 - 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. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/15821003/C_reactive_protein_in_the_prediction_of_cardiovascular_and_overall_mortality_in_middle_aged_men:_a_population_based_cohort_study_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehi237 DB - PRIME DP - Unbound Medicine ER -