Objective To assess associations between baseline values of four different circulating markers of inflammation and future risk of coronary heart disease, potential triggers of systemic inflammation (such as persistent infection), and other markers of inflammation. Design Nested case-control comparisons in a prospective, population based cohort. Setting General practices in 18 towns in Britain. Participants 506 men who died from coronary heart disease or had a non-fatal myocardial infarction and 1025 men who remained free of such disease until 1996 selected from 5661 men aged 40-59 years who provided blood samples in [1978][1979][1980]. Main outcome measures Plasma concentrations of C reactive protein, serum amyloid A protein, and serum albumin and leucocyte count. Information on fatal and non-fatal coronary heart disease was obtained from medical records and death certificates. Results Compared with men in the bottom third of baseline measurements of C reactive protein, men in the top third had an odds ratio for coronary heart disease of 2.13 (95% confidence interval 1.38 to 3.28) after age, town, smoking, vascular risk factors, and indicators of socioeconomic status were adjusted for. Similar adjusted odds ratios were 1.65 (1.07 to 2.55) for serum amyloid A protein; 1.12 (0.71 to 1.77) for leucocyte count; and 0.67 (0.43 to 1.04) for albumin. No strong associations were observed of these factors with Helicobacter pylori seropositivity, Chlamydia pneumoniae IgG titres, or plasma total homocysteine concentrations. Baseline values of the acute phase reactants were significantly associated with one another (P < 0.0001), although the association between low serum albumin concentration and leucocyte count was weaker (P = 0.08). Conclusion In the context of results from other relevant studies these findings suggest that some inflammatory processes, unrelated to the chronic infections studied here, are likely to be involved in coronary heart disease.
Background and Purpose-B-mode ultrasound is a noninvasive method of examining the walls of peripheral arteries and provides measures of the intima-media thickness (IMT) at various sites (common carotid artery, bifurcation, internal carotid artery) and of plaques that may indicate early presymptomatic disease. The reported associations between cardiovascular risk factors, clinical disease, IMT, and plaques are inconsistent. We sought to clarify these relationships in a large, representative sample of men and women living in 2 British towns. Methods-The study was performed during 1996 in 2 towns (Dewsbury and Maidstone) of the British Regional Heart Study that have an Ϸ2-fold difference in coronary heart disease risk. The male participants were drawn from the British Regional Heart Study and were recruited in 1978 -1980 and form part of a national cohort study of 7735 men. A random sample of women of similar age to the men (55 to 77 years) was also selected from the age-sex register of the general practices used in the original survey. A wide range of data on social, lifestyle, and physiological factors, cardiovascular disease symptoms, and diagnoses was collected. Measures of right and left common carotid IMT (IMT cca ) and bifurcation IMT (IMT bif ) were made, and the arteries were examined for plaques 1.5 cm above and below the flow divider. Results-Totals of 425 men and 375 women were surveyed (mean age, 66 years; range, 56 to 77 years). The mean (SD) IMT cca observed were 0.84 (0.21) and 0.75 (0.16) mm for men and women, respectively. The mean (SD) IMT bif were 1.69 (0.61) and 1.50 (0.77) mm for men and women, respectively. The correlation between IMT cca and IMT bif was similar in men (rϭ0.36) and women (rϭ0.38). There were no differences in mean IMT cca or IMT bif between the 2 towns. Carotid plaques were very common, affecting 57% (nϭ239) of men and 58% (nϭ211) of women. Severe carotid plaques with flow disturbance were rare, affecting 9 men (2%) and 6 women (1.6%). Plaques increased in prevalence with age, affecting 49% men and 39% of women aged Ͻ60 years and 65% and 75% of men and women, respectively, aged Ͼ70 years. Plaques were most common among men in Dewsbury (79% affected) and least common among men in Maidstone (34% affected). IMT cca showed a different pattern of association with cardiovascular risk factors from IMT bif and was associated with age, SBP, and FEV 1 but not with social, lifestyle, or other physiological risk factors. IMT bif and carotid plaques were associated with smoking, manual social class, and plasma fibrinogen. IMT bif and carotid plaques were associated with symptoms and diagnoses of cardiovascular diseases. IMT bif associations with cardiovascular risk factors and prevalent cardiovascular disease appeared to be explained by the presence of plaques in regression models and in analyses stratified by plaque status. Conclusions-IMT cca , IMT bif , and plaque are correlated with each other but show differing patterns of association with risk factors and prevalent disease. IMT cca ...
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