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Combining serum biomarkers: the association of C-reactive protein, insulin sensitivity, and homocysteine with cardiovascular disease history in the general US population.
Eur J Cardiovasc Prev Rehabil. 2006 Apr; 13(2):180-5.EJ

Abstract

BACKGROUND

Elevated levels of serum biomarkers such as C-reactive protein (CRP) and homocysteine have been independently associated with cardiovascular risk. However, the prevalence of concurrent elevations of these biomarkers in the general population is unknown, as is their association with cardiovascular disease (CVD).

METHODS

Data from adults (n = 4900) in the National Health and Nutrition Examination Survey were used to investigate the relationship between combinations of serum biomarkers of inflammation (CRP), atherosclerosis (homocysteine), and insulin sensitivity [homeostatic model assessment (HOMA) fasting insulin] and CVD. Using SUDAAN, logistic regression models were constructed to examine the relationships between elevated serum biomarkers (CRP, homocysteine, HOMA, or insulin), singly or in combination, and having a history of heart failure, myocardial infarction (MI), stroke, or any CVD, while controlling for age, race, sex, obesity, smoking, cholesterol level, diabetes history, hypertension history, exercise level, and dietary fiber intake.

RESULTS

After adjustment for covariates, there was a significant relationship between concomitant elevations of CRP plus homocysteine and a history of MI [odds ratio (OR) 2.21], heart failure (OR 2.14), and any CVD (OR 1.87) that was stronger than the relationship between individual biomarkers alone and a history of CVD. In addition, combinations of elevated CRP plus HOMA and CRP plus insulin, remained significantly related to having a history of any CVD.

CONCLUSION

Recent scientific evidence and the present findings demonstrate the possibility for improving cardiovascular risk stratification through the concurrent evaluation of multiple biomarkers. In particular, these findings demonstrate the need to evaluate the combination of CRP and homocysteine prospectively as predictors of CVD.

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Authors+Show Affiliations

Cummings DM
Brody School of Medicine, Department of Family Medicine, Greenville, North Carolina 27834, USA. cummingsd@mail.ecu.edu
King DE
No affiliation info available
Mainous AG
No affiliation info available
Geesey ME
No affiliation info available

MeSH

AdolescentAdultAgedBiomarkersC-Reactive ProteinCardiovascular DiseasesFastingFemaleHealth SurveysHeart FailureHomocysteineHumansInsulinMaleMiddle AgedMyocardial InfarctionOdds RatioRegression AnalysisRisk FactorsUnited States

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16575270

Citation

Cummings, Doyle M., et al. "Combining Serum Biomarkers: the Association of C-reactive Protein, Insulin Sensitivity, and Homocysteine With Cardiovascular Disease History in the General US Population." European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups On Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, vol. 13, no. 2, 2006, pp. 180-5.
Cummings DM, King DE, Mainous AG, et al. Combining serum biomarkers: the association of C-reactive protein, insulin sensitivity, and homocysteine with cardiovascular disease history in the general US population. Eur J Cardiovasc Prev Rehabil. 2006;13(2):180-5.
Cummings, D. M., King, D. E., Mainous, A. G., & Geesey, M. E. (2006). Combining serum biomarkers: the association of C-reactive protein, insulin sensitivity, and homocysteine with cardiovascular disease history in the general US population. European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups On Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, 13(2), 180-5.
Cummings DM, et al. Combining Serum Biomarkers: the Association of C-reactive Protein, Insulin Sensitivity, and Homocysteine With Cardiovascular Disease History in the General US Population. Eur J Cardiovasc Prev Rehabil. 2006;13(2):180-5. PubMed PMID: 16575270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combining serum biomarkers: the association of C-reactive protein, insulin sensitivity, and homocysteine with cardiovascular disease history in the general US population. AU - Cummings,Doyle M, AU - King,Dana E, AU - Mainous,Arch G, AU - Geesey,Mark E, PY - 2006/4/1/pubmed PY - 2006/10/6/medline PY - 2006/4/1/entrez SP - 180 EP - 5 JF - European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology JO - Eur J Cardiovasc Prev Rehabil VL - 13 IS - 2 N2 - BACKGROUND: Elevated levels of serum biomarkers such as C-reactive protein (CRP) and homocysteine have been independently associated with cardiovascular risk. However, the prevalence of concurrent elevations of these biomarkers in the general population is unknown, as is their association with cardiovascular disease (CVD). METHODS: Data from adults (n = 4900) in the National Health and Nutrition Examination Survey were used to investigate the relationship between combinations of serum biomarkers of inflammation (CRP), atherosclerosis (homocysteine), and insulin sensitivity [homeostatic model assessment (HOMA) fasting insulin] and CVD. Using SUDAAN, logistic regression models were constructed to examine the relationships between elevated serum biomarkers (CRP, homocysteine, HOMA, or insulin), singly or in combination, and having a history of heart failure, myocardial infarction (MI), stroke, or any CVD, while controlling for age, race, sex, obesity, smoking, cholesterol level, diabetes history, hypertension history, exercise level, and dietary fiber intake. RESULTS: After adjustment for covariates, there was a significant relationship between concomitant elevations of CRP plus homocysteine and a history of MI [odds ratio (OR) 2.21], heart failure (OR 2.14), and any CVD (OR 1.87) that was stronger than the relationship between individual biomarkers alone and a history of CVD. In addition, combinations of elevated CRP plus HOMA and CRP plus insulin, remained significantly related to having a history of any CVD. CONCLUSION: Recent scientific evidence and the present findings demonstrate the possibility for improving cardiovascular risk stratification through the concurrent evaluation of multiple biomarkers. In particular, these findings demonstrate the need to evaluate the combination of CRP and homocysteine prospectively as predictors of CVD. SN - 1741-8267 UR - https://www.unboundmedicine.com/medline/citation/16575270/Combining_serum_biomarkers:_the_association_of_C_reactive_protein_insulin_sensitivity_and_homocysteine_with_cardiovascular_disease_history_in_the_general_US_population_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=16575270.ui DB - PRIME DP - Unbound Medicine ER -