Relation of C-Reactive Protein and Coronary Heart Disease in the MRFIT Nested Case-Control Study

Abstract

The authors measured the relation between C-reactive protein, alpha 1 acid glycoprotein and albumin, an acute phase protein, and subsequent risk of myocardial infarction and coronary heart disease death in a nested case-control study among the Multiple Risk Factor Intervention Trial (MRFIT) participants. There were 98 myocardial infarction cases, 148 coronary heart disease deaths, and 491 controls. The cases and controls were followed for up to 17 years for deaths and 6-7 years for myocardial infarction cases and controls. There was a significant association between available distribution of C-reactive protein and subsequent coronary heart disease mortality. For smokers at baseline, the risk of coronary heart disease deaths in quartile 4 of C-reactive protein as compared with quartile 1 was 4.3 (95% confidence interval 1.74-10.8). The association persisted when adjusted for characteristics related to smoking and smoking cessation during the trial and to pulmonary function. There was no relation between alpha 1 acid glycoprotein and either myocardial infarction or coronary heart disease death. Albumin was inversely related to coronary heart disease death only for deaths that occurred between 7 and 13 years after baseline, consistent with previous MRFIT analyses. This is the first prospective study in "healthy but high risk individuals" to document the relation between C-reactive protein and coronary heart disease mortality.

C‐Reactive Protein Identifies Low‐Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer–Norfolk Prospective Population Study

“…We found similar associations for abdominally obese participants with elevated CRP levels showing an increased risk for CHD compared with abdominally obese participants with low CRP levels. Previous studies linking CRP levels to CHD were performed largely in populations with a lower prevalence of obesity than that of the current US population 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32. In the 2 largest published studies of CRP and CHD disease,25, 27 the mean body mass index (in  kg/m 2 ) of participants ranged from 25 to 26, lower than the recently reported mean of 28.7 in US adults,33 indicating the clinical need for data regarding CRP in obese populations.…”

C‐reactive protein as a marker for active coronary artery disease in patients with chest pain in the emergency room

“…Kuller et al, in a nested case-control study of stored samples of serum from 492 controls and 246 coronary event cases in the Multiple Risk Factor Intervention Trial, found that a raised CRP concentration at entry was a highly significant risk factor, 18 suggesting that CRP measurement may provide important prognostic information even before symptoms appear.…”

“…[14][15][16][17] In more recent years, several nested case-control and cohort studies have also reported that the risk for CVD was related to baseline CRP concentrations. 18,19 This relation was interpreted as a confirmation of the role of CRP itself as a risk factor for coronary disease by inducing mononuclear cells to express tissue factor, the initiator of the extrinsic pathway of coagulation, further stimulating vascular thrombosis. In addition, increased CRP concentrations in atherosclerotic patients usually reflect the inflammatory condition of the vascular wall, which may play an important role of changes in plaque morphology, rupture, and thrombosis.…”

Orosomucoid in urine is a powerful predictor of cardiovascular mortality in normoalbuminuric patients with type 2 diabetes at five years of follow-up

“…The differences observed for orosomucoid in serum in our study occur within the reference interval. Likewise, the subclinical increase of inflammatory markers such as Creactive protein, which has been found to be an independent risk marker of mortality in epidemiological studies [18,19], does not allow individual classification based on normal or elevated values. In contrast, the mean occurrence of UOER values 9−12 times higher than the upper reference value readily allows classification of individuals as either normal or abnormal regarding UOER.…”