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C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis

Gallacher, John Edward ORCID: https://orcid.org/0000-0002-2394-5299 2010. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. The Lancet 375 (9709) , pp. 132-140. 10.1016/S0140-6736(09)61717-7

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Abstract

Background Associations of C-reactive protein (CRP) concentration with risk of major diseases can best be assessed by long-term prospective follow-up of large numbers of people. We assessed the associations of CRP concentration with risk of vascular and non-vascular outcomes under diff erent circumstances. Methods We meta-analysed individual records of 160 309 people without a history of vascular disease (ie, 1·31 million person-years at risk, 27 769 fatal or non-fatal disease outcomes) from 54 long-term prospective studies. Within-study regression analyses were adjusted for within-person variation in risk factor levels. Results Loge CRP concentration was linearly associated with several conventional risk factors and infl ammatory markers, and nearly log-linearly with the risk of ischaemic vascular disease and non-vascular mortality. Risk ratios (RRs) for coronary heart disease per 1-SD higher loge CRP concentration (three-fold higher) were 1·63 (95% CI 1·51–1·76) when initially adjusted for age and sex only, and 1·37 (1·27–1·48) when adjusted further for conventional risk factors; 1·44 (1·32–1·57) and 1·27 (1·15–1·40) for ischaemic stroke; 1·71 (1·53–1·91) and 1·55 (1·37–1·76) for vascular mortality; and 1·55 (1·41–1·69) and 1·54 (1·40–1·68) for non-vascular mortality. RRs were largely unchanged after exclusion of smokers or initial follow-up. After further adjustment for fi brinogen, the corresponding RRs were 1·23 (1·07–1·42) for coronary heart disease; 1·32 (1·18–1·49) for ischaemic stroke; 1·34 (1·18–1·52) for vascular mortality; and 1·34 (1·20–1·50) for non-vascular mortality. Interpretation CRP concentration has continuous associations with the risk of coronary heart disease, ischaemic stroke, vascular mortality, and death from several cancers and lung disease that are each of broadly similar size. The relevance of CRP to such a range of disorders is unclear. Associations with ischaemic vascular disease depend considerably on conventional risk factors and other markers of infl ammation.

Item Type: Article
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Subjects: R Medicine > R Medicine (General)
Additional Information: Contributors: Stephen Kaptoge did the statistical analysis and drafted the report with John Danesh. All members of the writing committee provided critical revisions. All investigators shared individual data and had an opportunity to contribute to the interpretation of the results and to the redrafting of the report. The data management team collated and standardised the data. All members of the coordinating centre contributed to the collection, standardisation, analysis, and interpretation of the data. ERFC Investigators include: J. Gallacher.
Publisher: Elsevier
ISSN: 0140-6736
Last Modified: 19 Oct 2022 10:51
URI: https://orca.cardiff.ac.uk/id/eprint/25743

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