C-Reactive Protein, the Metabolic Syndrome, and Risk of Incident Cardiovascular Events: An 8-Year Follow-Up of 14 719 Initially Healthy American Women
Abstract
Background— The metabolic syndrome describes a high-risk population having 3 or more of the following clinical characteristics: upper-body obesity, hypertriglyceridemia, low HDL, hypertension, and abnormal glucose. All of these attributes, however, are associated with increased levels of C-reactive protein (CRP). Methods and Results— We evaluated interrelationships between CRP, the metabolic syndrome, and incident cardiovascular events among 14 719 apparently healthy women who were followed up for an 8-year period for myocardial infarction, stroke, coronary revascularization, or cardiovascular death; 24% of the cohort had the metabolic syndrome at study entry. At baseline, median CRP levels for those with 0, 1, 2, 3, 4, or 5 characteristics of the metabolic syndrome were 0.68, 1.09, 1.93, 3.01, 3.88, and 5.75 mg/L, respectively ( P trend <0.0001). Over the 8-year follow-up, cardiovascular event-free survival rates based on CRP levels above or below 3.0 mg/L were similar to survival rates based on having 3 or more characteristics of the metabolic syndrome. At all levels of severity of the metabolic syndrome, however, CRP added prognostic information on subsequent risk. For example, among those with the metabolic syndrome at study entry, age-adjusted incidence rates of future cardiovascular events were 3.4 and 5.9 per 1000 person-years of exposure for those with baseline CRP levels less than or greater than 3.0 mg/L, respectively. Additive effects for CRP were also observed for those with 4 or 5 characteristics of the metabolic syndrome. The use of different definitions of the metabolic syndrome had minimal impact on these findings. Conclusions— These prospective data suggest that measurement of CRP adds clinically important prognostic information to the metabolic syndrome.
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The MS may increase cardiovascular event risk through prothrombotic or inflammatory mechanisms rather than by accelerating atherosclerotic progression.
“Whereas the MS may play a limited role in accelerating atherosclerotic progression, it may significantly increase the risk of vascular events through prothrombotic or inflammatory mechanisms.29 -31”
From Diabetes, the Metabolic Syndrome, and Angiographic Progression of Coronary Arterial Disease in Postmenopausal Women (2006) · cites this paper as [30]
Many reports show that a proinflammatory state, as revealed by increased inflammatory markers, denotes higher risk for acute cardiovascular syndromes.
“Many reports also show that the presence of a proinflammatory state, as revealed by increased inflammatory markers, 95,96 denotes a higher risk for acute cardiovascular syndromes.”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [96]
Individuals with metabolic syndrome often exhibit a proinflammatory state, evidenced by increased cytokines such as TNF-alpha and interleukin-6 and acute-phase reactants such as CRP and fibrinogen.
“People with the metabolic syndrome frequently have a proinflammatory state as shown by elevated cytokines (eg, tumor necrosis factor-␣ and interleukin-6) and acute-phase reactants (eg, CRP, fibrinogen).96,184”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [96]
Elevated inflammatory proteins in obese individuals suggest that inflammation may play a determinant role in connecting obesity to metabolic, hepatic and cardiovascular diseases, and to some cancers.
“Elevated inflammatory proteins in obese individuals [1] suggest that inflammation may play a determinant role in connecting obesity to metabolic, hepatic and cardiovascular diseases [2], and to some cancers [3].”
From Adipose tissue transcriptomic signature highlights the pathological relevance of extracellular matrix in human obesity (2008) · cites this paper as [1]
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- Authors
- Ridker, P. M., Buring, J. E., Cook, N. R., & Rifai, N.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Circulation
- Published
- 2003-01-28
- Volume
- 107
- Issue
- 3
- Pages
- 391-397
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2142179136
- Cited by
- 2,292
- References
- 30
- Citations by year
- 2026: 27 · 2025: 24 · 2024: 37 · 2023: 35 · 2022: 40 · 2021: 62 · 2020: 38 · 2019: 43 · 2018: 63 · 2017: 64 · 2016: 58 · 2015: 94 · 2014: 98 · 2013: 86 · 2012: 114
- FWCI
- 142.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01hl043851-10)
- National Heart, Lung, and Blood Institute (R01HL058755, HL43851, HL 63293, HL-58755, R01HL063293)
- Topics
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- C-reactive protein, metabolic syndrome, cardiovascular events, cardiovascular risk prediction, women, myocardial infarction, stroke, cardiovascular mortality, inflammation, hypertriglyceridemia, low HDL cholesterol, hypertension, obesity
- MeSH terms
- Aged, C-Reactive Protein, Female, Follow-Up Studies, Heart Diseases, Humans, Middle Aged, Prognosis, Prospective Studies, Risk Factors, United States, Incidence, Prevalence, Disease-Free Survival, Metabolic Syndrome
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