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C-reactive protein, fibrinogen improved CV event prediction
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Adding assessment of C-reactive protein or fibrinogen levels to a prognostic model for CVD may prevent one additional CV event for every 400 to 500 people at intermediate risk for an event during a period of 10 years, according to new data published in the New England Journal of Medicine.
Researchers from the Emerging Risk Factors Collaboration analyzed data from 52 studies involving 246,669 participants without a history of CVD.
They found that including information on HDL in a CVD prediction model that incorporated age, sex, smoking status, BP, diabetes history and total cholesterol level increased the C-index — a measure of risk discrimination — by 0.005. The C-index was further increased by 0.0039 after incorporation of CRP levels and 0.0027 after incorporation of fibrinogen levels into the model (P<.001).
Net reclassification improvements were 1.52% and 0.83%, respectively, for predicted 10-year risk categories of low (<10%), intermediate (10% to <20%) and high (≥20%; P<.02 for both comparisons), according to the abstract.
Additionally, results suggested that using conventional risk factors alone would lead to 15,025 of 100,000 adults aged 40 years or older being initially classified as having intermediate risk for a CV event.
“Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines … additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional CV events over the course of 10 years,” the researchers concluded.
Disclosure: This study was supported by a grant from the British Heart Foundation, the U.K. Medical Research Council, the U.K. National Institute of Health Research Cambridge Biomedical Research Centre, a grant from the British United Provident Association Foundation, an unrestricted educational grant from GlaxoSmithKline and others through support of the cohorts contributing data to the Emerging Risk Factors Collaboration. See the study for a full list of researchers’ disclosures.
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