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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