C-REACTIVE PROTEIN ADDS TO THE PREDICTIVE VALUE OF TOTAL AND HDL CHOLESTEROL IN DETERMINING RISK OF FIRST MYOCARDIAL-INFARCTION

Background-C-reactive protein (CRP) is a sensitive marker of inflammat ion, and elevated levels have been associated with future risk of myoc ardial infarction (MI). However, whether measurement of CRP adds to th e predictive value of total cholesterol (TC) and HDL cholesterol (HDL- C) in determining risk is uncertain. Methods and Results-Among 14916 a pparently healthy men participating in the Physicians' Health Study, b aseline levels of CRP, TC, and HDL-C were measured among 245 study sub jects who subsequently developed a first MI (cases) and among 372 subj ects who remained free of cardiovascular disease during an average fol low-up period of 9 years (controls). In univariate analyses, high base line levels of CRP, TC, and TC:HDL-C ratio were each associated with s ignificantly increased risks of future MI tall P values <0.001). In mu ltivariate analyses, models incorporating CRP and lipid parameters pro vided a significantly better method to predict risk than did models us ing lipids alone tall likelihood ratio test P values <0.003). For exam ple, relative risks of future MI among those with high levels of both CRP and TC (RR=5.0, P=0.0001) were greater than the product of the ind ividual risks associated with isolated elevations of either CRP (RR=1. 5) or TC (RR=2.3). In stratified analyses, baseline CRP level was pred ictive of risk for those with low as well as high levels of TC and the TC:HDL-C ratio. These findings were virtually identical in analyses l imited to nonsmokers and after control for other cardiovascular risk f actors. Conclusions-In prospective data from a large cohort of apparen tly healthy men, baseline CRP level added to the predictive value of l ipid parameters in determining risk of first MI.