Skip to main content

C-reactive protein, fibrinogen, and cardiovascular disease prediction.

Publication ,  Journal Article
Emerging Risk Factors Collaboration, ; Kaptoge, S; Di Angelantonio, E; Pennells, L; Wood, AM; White, IR; Gao, P; Walker, M; Thompson, A; Deeg, D ...
Published in: N Engl J Med
October 4, 2012

BACKGROUND: There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. METHODS: We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen. RESULTS: The addition of information on high-density lipoprotein cholesterol to a prognostic model for cardiovascular disease that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (P<0.001), and yielded a net reclassification improvement of 1.52% and 0.83%, respectively, for the predicted 10-year risk categories of "low" (<10%), "intermediate" (10% to <20%), and "high" (≥20%) (P<0.02 for both comparisons). We estimated that among 100,000 adults 40 years of age or older, 15,025 persons would initially be classified as being at intermediate risk for a cardiovascular event if conventional risk factors alone were used to calculate risk. Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines (i.e., for persons with a predicted risk of ≥20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years. CONCLUSIONS: In a study of people without known cardiovascular disease, we estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened. (Funded by the British Heart Foundation and others.).

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

October 4, 2012

Volume

367

Issue

14

Start / End Page

1310 / 1320

Location

United States

Related Subject Headings

  • Risk Factors
  • Proportional Hazards Models
  • Prognosis
  • Practice Guidelines as Topic
  • Middle Aged
  • Mass Screening
  • Male
  • Lipids
  • Humans
  • General & Internal Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Emerging Risk Factors Collaboration, ., Kaptoge, S., Di Angelantonio, E., Pennells, L., Wood, A. M., White, I. R., … Danesh, J. (2012). C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med, 367(14), 1310–1320. https://doi.org/10.1056/NEJMoa1107477
Emerging Risk Factors Collaboration, John, Stephen Kaptoge, Emanuele Di Angelantonio, Lisa Pennells, Angela M. Wood, Ian R. White, Pei Gao, et al. “C-reactive protein, fibrinogen, and cardiovascular disease prediction.N Engl J Med 367, no. 14 (October 4, 2012): 1310–20. https://doi.org/10.1056/NEJMoa1107477.
Emerging Risk Factors Collaboration, Kaptoge S, Di Angelantonio E, Pennells L, Wood AM, White IR, et al. C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med. 2012 Oct 4;367(14):1310–20.
Emerging Risk Factors Collaboration, John, et al. “C-reactive protein, fibrinogen, and cardiovascular disease prediction.N Engl J Med, vol. 367, no. 14, Oct. 2012, pp. 1310–20. Pubmed, doi:10.1056/NEJMoa1107477.
Emerging Risk Factors Collaboration, Kaptoge S, Di Angelantonio E, Pennells L, Wood AM, White IR, Gao P, Walker M, Thompson A, Sarwar N, Caslake M, Butterworth AS, Amouyel P, Assmann G, Bakker SJL, Barr ELM, Barrett-Connor E, Benjamin EJ, Björkelund C, Brenner H, Brunner E, Clarke R, Cooper JA, Cremer P, Cushman M, Dagenais GR, D’Agostino RB, Dankner R, Davey-Smith G, Deeg D, Dekker JM, Engström G, Folsom AR, Fowkes FGR, Gallacher J, Gaziano JM, Giampaoli S, Gillum RF, Hofman A, Howard BV, Ingelsson E, Iso H, Jørgensen T, Kiechl S, Kitamura A, Kiyohara Y, Koenig W, Kromhout D, Kuller LH, Lawlor DA, Meade TW, Nissinen A, Nordestgaard BG, Onat A, Panagiotakos DB, Psaty BM, Rodriguez B, Rosengren A, Salomaa V, Kauhanen J, Salonen JT, Shaffer JA, Shea S, Ford I, Stehouwer CDA, Strandberg TE, Tipping RW, Tosetto A, Wassertheil-Smoller S, Wennberg P, Westendorp RG, Whincup PH, Wilhelmsen L, Woodward M, Lowe GDO, Wareham NJ, Khaw K-T, Sattar N, Packard CJ, Gudnason V, Ridker PM, Pepys MB, Thompson SG, Danesh J. C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med. 2012 Oct 4;367(14):1310–1320.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

October 4, 2012

Volume

367

Issue

14

Start / End Page

1310 / 1320

Location

United States

Related Subject Headings

  • Risk Factors
  • Proportional Hazards Models
  • Prognosis
  • Practice Guidelines as Topic
  • Middle Aged
  • Mass Screening
  • Male
  • Lipids
  • Humans
  • General & Internal Medicine