C-reactive protein may be a stronger predictor for cardiovascular disease than low-density lipoprotein cholesterol
C-reactive
protein may be a stronger predictor for cardiovascular disease than
low-density lipoprotein cholesterol, according to an article in
the November 14th issue of the New England Journal of Medicine.
The findings, drawn from an eight-year study of almost 28,000 women,
will generate considerable discussion over optimal screening for
cardiovascular risk and whether additional research is indicated
to see if there are gender differences in risk or risk assessment.
American researchers opened the Women’s Health
Study in 1992 to see whether or not aspirin or vitamin E has a role
in primary prevention of cardiovascular events. Women were at least
45 years of age at baseline, and 27,939 apparently healthy women
enrolled.
In the current work, investigators compared
data on enrollment (baseline) values of low-density lipoprotein
cholesterol and C-reactive protein with outcomes of myocardial infarction,
ischemic stroke, coronary revascularization, and cardiac mortality
during the follow-up period (mean, eight years).
The researchers established relative risk
after adjusting data for risk factors such as age, smoking, diabetes,
and blood pressure. Relative risk for first cardiovascular event
was 1.4, 1.6, 2.0, and 2.3 for increasing quintiles of C-reactive
protein compared with the value for women in the lowest quintile.
In contrast, relative risk was weaker ---0.9, 1.1, 1.3, and 1.5
--- for increasing quintiles of low-density lipoprotein cholesterol.
Overall, over three quarters of all cardiovascular
events (77 percent) occurred in women with low-density cholesterol
levels below 160 mg/dL, and almost half (46 percent) occurred in
women with levels below 130 mg/dL.
Ridker and his colleagues see the data on
the strength of C-reactive protein as an independent predictor as
confirmation that low-grade inflammation is a fundamental contributor
to cardiovascular disease. The finding that the combination of C-reactive
protein and low-density lipoprotein cholesterol was a better predictor
than either marker by itself may indicate that the two markers identify
different processes that result in high risk for cardiovascular
disease.
Although researchers and clinicians
will continue to debate what constitutes optimal screening, Ridker’s
final emphasis was on what is known--- measures to prevent cardiovascular
disease: “Until further research is conducted, the best way to maintain
good cardiovascular health is through smoking cessation, exercise,
and a healthy diet.”
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