Cited by 664Adipokines, Inflammation, and Metabolic DiseasesLipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and Lipoproteins

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C-Reactive Protein, the Metabolic Syndrome, and Prediction of Cardiovascular Events in the Framingham Offspring Study

Rutter, Martin K., Meigs, James B., Sullivan, Lisa M., D’Agostino, Ralph B., Wilson, Peter W.F.·2004·Circulation

DOI 10.1161/01.cir.0000136581.59584.0e

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Abstract

Background— Inflammation (assessed by C-reactive protein [CRP]) and the metabolic syndrome (MetS) are associated with cardiovascular disease (CVD), but population-based data are limited. Methods and Results— We assessed the cross-sectional relations of CRP to the MetS (National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III definition) in 3037 subjects (1681 women; mean age, 54 years) and the utility of CRP and the MetS to predict new CVD events (n=189) over 7 years. MetS (≥3 of 5 traits) was present in 24% of subjects; mean age-adjusted CRP levels for those with 0, 1, 2, 3, 4, or 5 MetS traits were 2.2, 3.5, 4.2, 6.0, or 6.6 mg/L, respectively ( P trend <0.0001). In persons with MetS, age-adjusted CRP levels were higher in women than men (7.8 versus 4.6 mg/L; P <0.0001). MetS and baseline CRP were individually related to CVD events (for MetS: age-sex-adjusted hazard ratio [HR], 2.1; 95% CI, 1.5 to 2.8; for highest versus lowest CRP quartile: HR, 2.2; 95% CI, 1.4 to 3.5). Greater risk of CVD persisted for MetS and CRP even after adjustment in a model including age, sex, MetS (HR, 1.8; 95% CI, 1.4 to 2.5), and CRP (HR, 1.9; 95% CI, 1.2 to 2.9). The c-statistic associated with the age- and sex-adjusted model including CRP was 0.72; including MetS, 0.74; and including CRP and MetS, 0.74. Conclusions— Elevated CRP levels are related to insulin resistance and the presence of the MetS, especially in women. Although discrimination of subjects at risk of CVD events using both MetS and CRP is not better than using either phenotype alone, both CRP and MetS are independent predictors of new CVD events.

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“An analysis of the Framingham Offspring Study cohort yielded similar results (8).”
Result
Predictability of Survival Models for Waiting List and Transplant Patients: Calculating LYFT
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Increased levels of the calcification marker Matrix Gla Protein and the inflammatory markers YKL-40 and CRP in patients with type 2 diabetes and ischemic heart disease
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Relation of Left Ventricular Hypertrophy to Microalbuminuria and C-Reactive Protein in Children and Adolescents with Essential Hypertension
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Background
Overexpression of Human C-Reactive Protein Exacerbates Left Ventricular Remodeling in Diabetic Cardiomyopathy
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How well does the metabolic syndrome defined by five definitions predict incident diabetes and incident coronary heart disease in a Chinese population?
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C-reactive protein induces pro- and anti-inflammatory effects, including activation of the liver X receptor α, on human monocytes
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The metabolic syndrome and nonfatal ischemic heart disease; a population-based study
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“This is consistent with other studies in humans, since it has been reported that hs-CRP levels are increased in subjects with signs of health disorders from metabolic abnormality [42]; this increase may also heighten the risk of cardiovascular disease [43].”
Result
High Sensitivity C-Reactive Protein, Tumor Necrosis Factor-α, Interleukin-6, and Vascular Cell Adhesion Molecule-1 Levels in Asian Indians with Metabolic Syndrome and Insulin Resistance (CURES-105)
Indulekha, K., Surendar, J., & Mohan, V. (2011) · Journal of Diabetes Science and Technology · doi:10.1177/193229681100500421 · Cited by 59
Funciones de riesgo en la prevención primaria de las enfermedades cardiovasculares
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Prevalence and correlates of metabolic syndrome (MS) in older adults
Cankurtaran, M., Halil, M. G., Doğu, B. B., Dağlı, N., Oyan, B., & Arıoğul, S. (2005) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2005.05.004 · Cited by 59
Metabolic Syndrome and the Risk of Ischemic Heart Disease and Stroke among Middle-Aged Japanese
Chei, C., Yamagishi, K., Tanigawa, T., Kitamura, A., Imano, H., Kiyama, M., Sato, S., & Iso, H. (2008) · Hypertension Research · doi:10.1291/hypres.31.1887 · Cited by 57
Effects of supplemental long-chain omega-3 fatty acids and erythrocyte membrane fatty acid content on circulating inflammatory markers in a randomized controlled trial of healthy adults
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Background
A longitudinal study over 40 years to study the metabolic syndrome as a risk factor for cardiovascular diseases
Lind, L., Sundström, J., Ärnlöv, J., Risérus, U., & Lampa, E. (2021) · Scientific Reports · doi:10.1038/s41598-021-82398-8 · Cited by 57
Alternative Performance Measures for Prediction Models
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Metabolic syndrome and its associated risk factors in Brazilian postmenopausal women
Nahás, E. A. P., Padoani, N. P., Nahás-Neto, J., Orsatti, F. L., Tardivo, A. P., & Dias, R. (2009) · Climacteric · doi:10.1080/13697130902718168 · Cited by 57
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Metabolic syndrome, haemostatic and inflammatory markers, cerebrovascular and peripheral arterial disease: The Edinburgh Artery Study
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Serum ferritin level is associated with the prevalence of metabolic syndrome in Korean adults: The 2007–2008 Korean National Health and Nutrition Examination Survey
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Metabolic Syndrome and Cardiovascular Disease
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“CRP enhanced the prognostic utility of the metabolic syndrome in the West of Scotland Coronary Prevention Study (Sattar et al., 2003).”
Impact of Metabolic Syndrome on the Long-Term Survival of Patients With Acute Myocardial Infarction Potential Association With C-Reactive Protein
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Metabolic syndrome in peripheral arterial disease: relationship with severity of peripheral circulatory insufficiency, inflammatory status, and cardiovascular comorbidity
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Metabolic Syndrome, Insulin Resistance and Systemic Inflammation as Risk Factors for Reduced Lung Function in Korean Nonsmoking Males
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“Moreover, considerable attention is being paid to the relationship between systemic inflammation, IR and MetS (8, 9).”
Background
Metabolic Syndrome
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Background
Pathophysiologic Mechanisms of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome
Zamarrón, C., Valdés, L., & Álvarez-Sala, R. (2013) · Pulmonary Medicine · doi:10.1155/2013/521087 · Cited by 58
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Oxidative Stress and Adverse Adipokine Profile Characterize the Metabolic Syndrome in Children
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Background
Total n-3 polyunsaturated fatty acid intake is inversely associated with serum C-reactive protein in young Japanese women
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The relationship between the morning blood pressure surge and low-grade inflammation on silent cerebral infarct and clinical stroke events
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Dyke, M. E. V., Vaccarino, V., Dunbar, S. B., Pemu, P. E., Gibbons, G. H., Quyyumi, A. A., & Lewis, T. T. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.04.009 · Cited by 54
“CRP is a marker of inflammation that has been linked to an increased risk of cardiovascular events (Cushman et al., 2009; Ridker et al., 2000; Rutter et al., 2004).”
Background
Plasma adrenomedullin as an independent predictor of future cardiovascular events in high-risk patients: Comparison with C-reactive protein and adiponectin
Nishida, H., Horio, T., Suzuki, Y., Iwashima, Y., Kamide, K., Kangawa, K., & Kawano, Y. (2007) · Peptides · doi:10.1016/j.peptides.2007.12.006 · Cited by 51

Authors: Rutter, M. K., Meigs, J. B., Sullivan, L. M., D’Agostino, R. B., & Wilson, P. W. F.
Affiliations: Boston University (US)
ORCID: Rutter, Martin K.
Meigs, James B.
Sullivan, Lisa M.
D’Agostino, Ralph B.
Wilson, Peter W.F.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2004-07-27
Volume: 110
Issue: 4
Pages: 380-385
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.0000136581.59584.0e
OpenAlex: W1983997573
Cited by: 664
References: 36
Citations by year: 2026: 4 · 2025: 7 · 2024: 9 · 2023: 15 · 2022: 19 · 2021: 9 · 2020: 8 · 2019: 11 · 2018: 15 · 2017: 13 · 2016: 19 · 2015: 20 · 2014: 36 · 2013: 36 · 2012: 26
FWCI: 48.38
Type: journal article
Language: en
Open access: closed
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Research Explorer (The University of Manchester) (submittedVersion)
Funders: National Institutes of Health (n01hc25195-41-0-1)
National Heart, Lung, and Blood Institute (R01HL073272, N01‐HC25195, R01-HL 073272-01)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: C-reactive protein, metabolic syndrome, cardiovascular risk prediction, inflammation, insulin resistance, sex differences, Framingham Offspring Study, cardiovascular events, risk discrimination, cardiovascular risk in women, NCEP ATP III criteria, Framingham risk score, Framingham risk equation
MeSH terms: Adult, Aged, Aged, 80 and over, C-Reactive Protein, Cardiovascular Diseases, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Inflammation, Insulin Resistance, Male, Middle Aged, Predictive Value of Tests, Risk, Sex Factors, Cohort Studies, Metabolic Syndrome

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C-Reactive Protein, the Metabolic Syndrome, and Prediction of Cardiovascular Events in the Framingham Offspring Study

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