Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses

Objective To assess associations between baseline values of four different circulating markers of inflammation and future risk of coronary heart disea se, potential triggers of systemic inflammation (such as persistent infecti on), and other markers of inflammation. Design Nested case-control comparisons in a prospective, population based c ohort. Setting General practices in 18 towns in Britain. Participants 506 men who died from coronary heart disease or had a non-fata l myocardial infarction and 1025 men who remained free of such disease unti l 1996 selected from 5661 men aged 40-59 years who provided blood samples i n 1978-1980. Main outcome measures Plasma concentrations of C reactive protein, serum am yloid A protein, and serum albumin and leucocyte count Information on fatal and non-fatal coronary heart disease was obtained from medical records and death certificates. Results Compared with men in the bottom third of baseline measurements of C reactive protein, men in the top third had an odds ratio for coronary hear t disease of 2.13 (95% confidence interval 1.38 to 3.28) after age, town, s moking, vascular risk factors, and indicators of socioeconomic status were adjusted for. Similar adjusted odds ratios were 1.65 (1.07 to 2.55) for ser um amyloid A protein; 1.12 (0.71 to 1.77) for leucocyte count; and 0.67 (0. 43 to 1.04) for albumin. No strong associations were observed of these fact ors with Helicobacter pylori seropositivity, Chlamydia pneumoniae IgG titre s, or plasma total homocysteine concentrations. Baseline values of the acut e phase reactants were significantly associated with one another (P < 0.000 1), although the association between low serum albumin concentration and le ucocyte count was weaker (P = 0.08). Conclusion In the context of results from other relevant studies these find ings suggest that some inflammatory processes, unrelated to the chronic inf ections studied here, are likely to be involved in coronary heart disease.