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Association of carotid artery intima-media thickness, plaques, and C-reactive protein with future cardiovascular disease and all-cause mortality: the Cardiovascular Health Study.

Abstract

BACKGROUND

Carotid atherosclerosis, measured as carotid intima-media thickness or as characteristics of plaques, has been linked to cardiovascular disease (CVD) and to C-reactive protein (CRP) levels. We investigated the relationship between carotid atherosclerosis and CRP and their joint roles in CVD prediction.

METHODS AND RESULTS

Of 5888 participants in the Cardiovascular Health Study, an observational study of adults aged > or = 65 years, 5020 without baseline CVD were included in the analysis. They were followed up for as long as 12 years for CVD incidence and all-cause mortality after baseline ultrasound and CRP measurement. When CRP was elevated (> 3 mg/L) among those with detectable atherosclerosis on ultrasound, there was a 72% (95% CI, 1.46 to 2.01) increased risk for CVD death and a 52% (95% CI, 1.37 to 1.68) increased risk for all-cause mortality. Elevated CRP in the absence of atherosclerosis did not increase CVD or all-cause mortality risk. The proportion of excess risk attributable to the interaction of high CRP and atherosclerosis was 54% for CVD death and 79% for all-cause mortality. Addition of CRP or carotid atherosclerosis to conventional risk factors modestly increased in the ability to predict CVD, as measured by the c statistic.

CONCLUSIONS

In older adults, elevated CRP was associated with increased risk for CVD and all-cause mortality only in those with detectable atherosclerosis based on carotid ultrasound. Despite the significant associations of CRP and carotid atherosclerosis with CVD, these measures modestly improve the prediction of CVD outcomes after one accounts for the conventional risk factors.

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  • Authors+Show Affiliations

    ,

    National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, MSC 1061, Bldg 10, Room B1D-416, Bethesda, MD 20892, USA. caoj@nhlbi.nih.gov

    , , , , , ,

    Source

    Circulation 116:1 2007 Jul 03 pg 32-8

    MeSH

    African Americans
    Aged
    Biomarkers
    C-Reactive Protein
    Cardiovascular Diseases
    Carotid Artery Diseases
    Cohort Studies
    Comorbidity
    Diabetes Mellitus
    European Continental Ancestry Group
    Female
    Follow-Up Studies
    Humans
    Hyperlipidemias
    Hypertension
    Incidence
    Inflammation
    Kaplan-Meier Estimate
    Male
    Mass Screening
    Mortality
    Myocardial Infarction
    Obesity
    Predictive Value of Tests
    Proportional Hazards Models
    Prospective Studies
    ROC Curve
    Risk Assessment
    Risk Factors
    Smoking
    Stroke
    Survival Analysis
    Tunica Intima
    Tunica Media
    Ultrasonography
    United States

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    17576871

    Citation

    Cao, Jie J., et al. "Association of Carotid Artery Intima-media Thickness, Plaques, and C-reactive Protein With Future Cardiovascular Disease and All-cause Mortality: the Cardiovascular Health Study." Circulation, vol. 116, no. 1, 2007, pp. 32-8.
    Cao JJ, Arnold AM, Manolio TA, et al. Association of carotid artery intima-media thickness, plaques, and C-reactive protein with future cardiovascular disease and all-cause mortality: the Cardiovascular Health Study. Circulation. 2007;116(1):32-8.
    Cao, J. J., Arnold, A. M., Manolio, T. A., Polak, J. F., Psaty, B. M., Hirsch, C. H., ... Cushman, M. (2007). Association of carotid artery intima-media thickness, plaques, and C-reactive protein with future cardiovascular disease and all-cause mortality: the Cardiovascular Health Study. Circulation, 116(1), pp. 32-8.
    Cao JJ, et al. Association of Carotid Artery Intima-media Thickness, Plaques, and C-reactive Protein With Future Cardiovascular Disease and All-cause Mortality: the Cardiovascular Health Study. Circulation. 2007 Jul 3;116(1):32-8. PubMed PMID: 17576871.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Association of carotid artery intima-media thickness, plaques, and C-reactive protein with future cardiovascular disease and all-cause mortality: the Cardiovascular Health Study. AU - Cao,Jie J, AU - Arnold,Alice M, AU - Manolio,Teri A, AU - Polak,Joseph F, AU - Psaty,Bruce M, AU - Hirsch,Calvin H, AU - Kuller,Lewis H, AU - Cushman,Mary, Y1 - 2007/06/18/ PY - 2007/6/20/pubmed PY - 2007/7/21/medline PY - 2007/6/20/entrez SP - 32 EP - 8 JF - Circulation JO - Circulation VL - 116 IS - 1 N2 - BACKGROUND: Carotid atherosclerosis, measured as carotid intima-media thickness or as characteristics of plaques, has been linked to cardiovascular disease (CVD) and to C-reactive protein (CRP) levels. We investigated the relationship between carotid atherosclerosis and CRP and their joint roles in CVD prediction. METHODS AND RESULTS: Of 5888 participants in the Cardiovascular Health Study, an observational study of adults aged > or = 65 years, 5020 without baseline CVD were included in the analysis. They were followed up for as long as 12 years for CVD incidence and all-cause mortality after baseline ultrasound and CRP measurement. When CRP was elevated (> 3 mg/L) among those with detectable atherosclerosis on ultrasound, there was a 72% (95% CI, 1.46 to 2.01) increased risk for CVD death and a 52% (95% CI, 1.37 to 1.68) increased risk for all-cause mortality. Elevated CRP in the absence of atherosclerosis did not increase CVD or all-cause mortality risk. The proportion of excess risk attributable to the interaction of high CRP and atherosclerosis was 54% for CVD death and 79% for all-cause mortality. Addition of CRP or carotid atherosclerosis to conventional risk factors modestly increased in the ability to predict CVD, as measured by the c statistic. CONCLUSIONS: In older adults, elevated CRP was associated with increased risk for CVD and all-cause mortality only in those with detectable atherosclerosis based on carotid ultrasound. Despite the significant associations of CRP and carotid atherosclerosis with CVD, these measures modestly improve the prediction of CVD outcomes after one accounts for the conventional risk factors. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/17576871/Association_of_carotid_artery_intima_media_thickness_plaques_and_C_reactive_protein_with_future_cardiovascular_disease_and_all_cause_mortality:_the_Cardiovascular_Health_Study_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.106.645606?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -