Cited by 3,604Lipoproteins and Cardiovascular HealthCardiovascular Health and Risk FactorsDiabetes, Cardiovascular Risks, and Lipoproteins

Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events

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Ridker, Paul M., Rifai, Nader, Rose, Lynda, Buring, Julie E., Cook, Nancy R.·2002·New England Journal of Medicine

Abstract

BACKGROUND: Both C-reactive protein and low-density lipoprotein (LDL) cholesterol levels are elevated in persons at risk for cardiovascular events. However, population-based data directly comparing these two biologic markers are not available. METHODS: C-reactive protein and LDL cholesterol were measured at base line in 27,939 apparently healthy American women, who were then followed for a mean of eight years for the occurrence of myocardial infarction, ischemic stroke, coronary revascularization, or death from cardiovascular causes. We assessed the value of these two measurements in predicting the risk of cardiovascular events in the study population. RESULTS: Although C-reactive protein and LDL cholesterol were minimally correlated (r=0.08), base-line levels of each had a strong linear relation with the incidence of cardiovascular events. After adjustment for age, smoking status, the presence or absence of diabetes mellitus, categorical levels of blood pressure, and use or nonuse of hormone-replacement therapy, the relative risks of first cardiovascular events according to increasing quintiles of C-reactive protein, as compared with the women in the lowest quintile, were 1.4, 1.6, 2.0, and 2.3 (P<0.001), whereas the corresponding relative risks in increasing quintiles of LDL cholesterol, as compared with the lowest, were 0.9, 1.1, 1.3, and 1.5 (P<0.001). Similar effects were observed in separate analyses of each component of the composite end point and among users and nonusers of hormone-replacement therapy. Overall, 77 percent of all events occurred among women with LDL cholesterol levels below 160 mg per deciliter (4.14 mmol per liter), and 46 percent occurred among those with LDL cholesterol levels below 130 mg per deciliter (3.36 mmol per liter). By contrast, because C-reactive protein and LDL cholesterol measurements tended to identify different high-risk groups, screening for both biologic markers provided better prognostic information than screening for either alone. Independent effects were also observed for C-reactive protein in analyses adjusted for all components of the Framingham risk score. CONCLUSIONS: These data suggest that the C-reactive protein level is a stronger predictor of cardiovascular events than the LDL cholesterol level and that it adds prognostic information to that conveyed by the Framingham risk score.

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  • C-reactive protein is a stronger independent risk factor for cardiovascular disease than the low-density lipoprotein cholesterol level.

    “CRP has emerged as a particularly stronger independent risk factor for cardiovascular disease than the low-density lipoprotein cholesterol level [13, 33, 34].”

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  1. Centers for Disease Control/American Heart Association Workshop on Inflammatory Markers and Cardiovascular Disease: application to clinical and public health practice, Atlanta, March 14-15, 2002. Atlanta: Centers for Disease Control and Prevention, 2002.

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Authors
Ridker, P. M., Rifai, N., Rose, L., Buring, J. E., & Cook, N. R.
Affiliations
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
Venue
New England Journal of Medicine
Published
2002-11-14
Volume
347
Issue
20
Pages
1557-1565
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2032485049
Cited by
3,604
References
30
Citations by year
2026: 55 · 2025: 66 · 2024: 85 · 2023: 59 · 2022: 68 · 2021: 84 · 2020: 79 · 2019: 81 · 2018: 83 · 2017: 81 · 2016: 104 · 2015: 136 · 2014: 128 · 2013: 152 · 2012: 190
FWCI
243.86
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Doris Duke Charitable Foundation
  • Brigham and Women's Hospital
  • Fondation Leducq
  • National Institutes of Health (5r01hl043851-10)
  • National Heart, Lung, and Blood Institute (R01HL058755, HL43851, HL 63293, HL-58755, R01HL063293)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
C-reactive protein, LDL cholesterol, cardiovascular risk prediction, cardiovascular events, myocardial infarction, ischemic stroke, coronary revascularization, cardiovascular mortality, women, hormone replacement therapy, Framingham risk score, biomarkers, risk stratification
MeSH terms
Aged, C-Reactive Protein, Cardiovascular Diseases, Female, Humans, Cholesterol, LDL, Longitudinal Studies, Middle Aged, Prognosis, Risk, Risk Factors, ROC Curve, Biomarkers, Incidence, Multivariate Analysis, Disease-Free Survival, Hormone Replacement Therapy

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