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C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease.

https://arctichealth.org/en/permalink/ahliterature180683
Source
N Engl J Med. 2004 Apr 1;350(14):1387-97
Publication Type
Article
Date
Apr-1-2004
Author
John Danesh
Jeremy G Wheeler
Gideon M Hirschfield
Shinichi Eda
Gudny Eiriksdottir
Ann Rumley
Gordon D O Lowe
Mark B Pepys
Vilmundur Gudnason
Author Affiliation
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.
Source
N Engl J Med. 2004 Apr 1;350(14):1387-97
Date
Apr-1-2004
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
Blood Sedimentation
C-Reactive Protein - analysis
Case-Control Studies
Coronary Disease - blood
Female
Humans
Inflammation - blood
Male
Meta-Analysis as Topic
Middle Aged
Odds Ratio
Prospective Studies
Risk
Risk factors
von Willebrand Factor - analysis
Abstract
C-reactive protein is an inflammatory marker believed to be of value in the prediction of coronary events. We report data from a large study of C-reactive protein and other circulating inflammatory markers, as well as updated meta-analyses, to evaluate their relevance to the prediction of coronary heart disease.
Measurements were made in samples obtained at base line from up to 2459 patients who had a nonfatal myocardial infarction or died of coronary heart disease during the study and from up to 3969 controls without a coronary heart disease event in the Reykjavik prospective study of 18,569 participants. Measurements were made in paired samples obtained an average of 12 years apart from 379 of these participants in order to quantify within-person fluctuations in inflammatory marker levels.
The long-term stability of C-reactive protein values (within-person correlation coefficient, 0.59; 95 percent confidence interval, 0.52 to 0.66) was similar to that of both blood pressure and total serum cholesterol. After adjustment for base-line values for established risk factors, the odds ratio for coronary heart disease was 1.45 (95 percent confidence interval, 1.25 to 1.68) in a comparison of participants in the top third of the group with respect to base-line C-reactive protein values with those in the bottom third, and similar overall findings were observed in an updated meta-analysis involving a total of 7068 patients with coronary heart disease. By comparison, the odds ratios in the Reykjavik Study for coronary heart disease were somewhat weaker for the erythrocyte sedimentation rate (1.30; 95 percent confidence interval, 1.13 to 1.51) and the von Willebrand factor concentration (1.11; 95 percent confidence interval, 0.97 to 1.27) but generally stronger for established risk factors, such as an increased total cholesterol concentration (2.35; 95 percent confidence interval, 2.03 to 2.74) and cigarette smoking (1.87; 95 percent confidence interval, 1.62 to 2.16).
C-reactive protein is a relatively moderate predictor of coronary heart disease. Recommendations regarding its use in predicting the likelihood of coronary heart disease may need to be reviewed.
Notes
Comment In: N Engl J Med. 2004 Jul 15;351(3):295-8; author reply 295-815257564
Comment In: N Engl J Med. 2004 Jul 15;351(3):295-8; author reply 295-815254289
Comment In: N Engl J Med. 2004 Apr 1;350(14):1450-215070796
Comment In: N Engl J Med. 2004 Jul 15;351(3):295-8; author reply 295-815257565
Comment In: ACP J Club. 2004 Sep-Oct;141(2):5115341471
Comment In: N Engl J Med. 2004 Jul 15;351(3):295-8; author reply 295-815257563
PubMed ID
15070788 View in PubMed
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Serum uric acid and coronary heart disease in 9,458 incident cases and 155,084 controls: prospective study and meta-analysis.

https://arctichealth.org/en/permalink/ahliterature53184
Source
PLoS Med. 2005 Mar;2(3):e76
Publication Type
Article
Date
Mar-2005
Author
Jeremy G Wheeler
Kelsey D M Juzwishin
Gudny Eiriksdottir
Vilmundur Gudnason
John Danesh
Author Affiliation
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, United Kingdom.
Source
PLoS Med. 2005 Mar;2(3):e76
Date
Mar-2005
Language
English
Publication Type
Article
Abstract
BACKGROUND: It has been suggested throughout the past fifty years that serum uric acid concentrations can help predict the future risk of coronary heart disease (CHD), but the epidemiological evidence is uncertain. METHODS AND FINDINGS: We report a "nested" case-control comparison within a prospective study in Reykjavik, Iceland, using baseline values of serum uric acid in 2,456 incident CHD cases and in 3,962 age- and sex-matched controls, plus paired serum uric acid measurements taken at baseline and, on average, 12 y later in 379 participants. In addition, we conducted a meta-analysis of 15 other prospective studies in eight countries conducted in essentially general populations. Compared with individuals in the bottom third of baseline measurements of serum uric acid in the Reykjavik study, those in the top third had an age- and sex-adjusted odds ratio for CHD of 1.39 (95% confidence interval [CI], 1.23-1.58) which fell to 1.12 (CI, 0.97-1.30) after adjustment for smoking and other established risk factors. Overall, in a combined analysis of 9,458 cases and 155,084 controls in all 16 relevant prospective studies, the odds ratio was 1.13 (CI, 1.07-1.20), but it was only 1.02 (CI, 0.91-1.14) in the eight studies with more complete adjustment for possible confounders. CONCLUSIONS: Measurement of serum uric acid levels is unlikely to enhance usefully the prediction of CHD, and this factor is unlikely to be a major determinant of the disease in general populations.
PubMed ID
15783260 View in PubMed
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