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C-reactive protein: relation to total mortality, cardiovascular mortality and cardiovascular risk factors in men

Mendall, M. A., Strachan, D. P., Butland, B. K., Ballam, L., Morris, J., Sweetnam, P. M. and Elwood, Peter Creighton 2000. C-reactive protein: relation to total mortality, cardiovascular mortality and cardiovascular risk factors in men. European Heart Journal 21 (19) , pp. 1584-1590. 10.1053/euhj.1999.1982

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Background There is much interest in reported associations between serum C-reactive protein and incident ischaemic heart disease. It is uncertain what this association represents. We aimed to assess the effect of confounding from a number of different sources in the Caerphilly Prospective Heart Disease Study and in particular whether the low grade inflammation indicated by C-reactive protein may be the mechanism whereby non-circulating risk factors may influence pathogenesis of ischaemic heart disease. Methods Plasma specimens collected during 1979–83 from 1395 men with sufficient sample remaining were assayed for serum C-reactive protein by ELISA. Subsequent mortality and incident ischaemic heart disease events were ascertained from death certificates, hospital records and electrocardiographic changes at 5-yearly follow-up examinations. Results There was a positive association between C-reactive protein and incident ischaemic heart disease (P<0·005) mainly with fatal disease (P<0·002). There was also a positive association with all-cause mortality (P<0·0001). C-reactive protein was significantly associated with a number of non-circulating risk factors including body mass index (P<0·0001), smoking (P<0·0001), low forced expiratory volume in 1 s (P<0·0001), height (P=0·025), low childhood social class (P=0·014) and age (P=0·036). C-reactive protein was also associated positively with circulating risk factors including viscosity, leukocyte count, fibrinogen (all P<0·0001) and insulin (P=0·0058). After adjustment for non-circulating risk factors the association with all-incident ischaemic heart disease and ischaemic heart disease death became non-significant, but the association with all-cause mortality remained (P=0·033). Further adjustment for fibrinogen however removed any hint of an increasing trend in odds for all three outcomes. Conclusion C-reactive protein levels are raised in association with a variety of established cardiovascular risk factors. Neither C-reactive protein nor the systemic inflammation it represents appears to play a direct role in the development of ischaemic heart disease.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RZ Other systems of medicine
Uncontrolled Keywords: C-reactive protein, inflammation, ischaemic heart disease, all-cause mortality
Publisher: Oxford University Press
ISSN: 0195-668X
Last Modified: 04 Jun 2017 06:52

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