Cited by 5,850Lipoproteins and Cardiovascular HealthInflammatory Biomarkers in Disease PrognosisAdipokines, Inflammation, and Metabolic Diseases

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C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women

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Ridker, Paul M., Hennekens, Charles H., Buring, Julie E., Rifai, Nader·2000·New England Journal of Medicine

DOI 10.1056/nejm200003233421202

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Abstract

BACKGROUND: Since inflammation is believed to have a role in the pathogenesis of cardiovascular events, measurement of markers of inflammation has been proposed as a method to improve the prediction of the risk of these events. METHODS: We conducted a prospective, nested case-control study among 28,263 apparently healthy postmenopausal women over a mean follow-up period of three years to assess the risk of cardiovascular events associated with base-line levels of markers of inflammation. The markers included high-sensitivity C-reactive protein (hs-CRP), serum amyloid A, interleukin-6, and soluble intercellular adhesion molecule type 1 (sICAM-1). We also studied homocysteine and a variety of lipid and lipoprotein measurements. Cardiovascular events were defined as death from coronary heart disease, nonfatal myocardial infarction or stroke, or the need for coronary-revascularization procedures. RESULTS: Of the 12 markers measured, hs-CRP was the strongest univariate predictor of the risk of cardiovascular events; the relative risk of events for women in the highest as compared with the lowest quartile for this marker was 4.4 (95 percent confidence interval, 2.2 to 8.9). Other markers significantly associated with the risk of cardiovascular events were serum amyloid A (relative risk for the highest as compared with the lowest quartile, 3.0), sICAM-1 (2.6), interleukin-6 (2.2), homocysteine (2.0), total cholesterol (2.4), LDL cholesterol (2.4), apolipoprotein B-100 (3.4), HDL cholesterol (0.3), and the ratio of total cholesterol to HDL cholesterol (3.4). Prediction models that incorporated markers of inflammation in addition to lipids were significantly better at predicting risk than models based on lipid levels alone (P<0.001). The levels of hs-CRP and serum amyloid A were significant predictors of risk even in the subgroup of women with LDL cholesterol levels below 130 mg per deciliter (3.4 mmol per liter), the target for primary prevention established by the National Cholesterol Education Program. In multivariate analyses, the only plasma markers that independently predicted risk were hs-CRP (relative risk for the highest as compared with the lowest quartile, 1.5; 95 percent confidence interval, 1.1 to 2.1) and the ratio of total cholesterol to HDL cholesterol (relative risk, 1.4; 95 percent confidence interval, 1.1 to 1.9). CONCLUSIONS: The addition of the measurement of C-reactive protein to screening based on lipid levels may provide an improved method of identifying persons at risk for cardiovascular events.

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Authors: Ridker, P. M., Hennekens, C. H., Buring, J. E., & Rifai, N.
Affiliations: Brigham and Women's Hospital (US)
Boston Children's Hospital (US)
ORCID: Ridker, Paul M.
Hennekens, Charles H.
Buring, Julie E.
Rifai, Nader
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2000-03-23
Volume: 342
Issue: 12
Pages: 836-843
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm200003233421202
OpenAlex: W2058610272
Cited by: 5,850
References: 30
Citations by year: 2026: 97 · 2025: 120 · 2024: 113 · 2023: 125 · 2022: 148 · 2021: 143 · 2020: 165 · 2019: 140 · 2018: 167 · 2017: 131 · 2016: 169 · 2015: 199 · 2014: 223 · 2013: 234 · 2012: 258
FWCI: 286.27
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
University Libraries (University of Maryland) (submittedVersion)
Digital Repository at the University of Maryland (University of Maryland College Park)
Funders: National Institutes of Health (5r01hl043851-10)
National Heart, Lung, and Blood Institute (R01HL058755, HL43851, HL-58755)
National Cancer Institute (CA-47988, R01CA047988)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
Keywords: C-reactive protein, inflammatory markers, cardiovascular risk prediction, postmenopausal women, serum amyloid A, interleukin-6, sICAM-1, homocysteine, apolipoprotein B-100, LDL cholesterol, coronary artery disease, myocardial infarction, stroke, coronary revascularization, risk prediction model
MeSH terms: Serum Amyloid A Protein, Analysis of Variance, Apolipoproteins, C-Reactive Protein, Cardiovascular Diseases, Female, Homocysteine, Humans, Lipids, Middle Aged, Prospective Studies, Protein Precursors, Risk, Biomarkers, Interleukin-6, Case-Control Studies, Intercellular Adhesion Molecule-1

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C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women

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