Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events
Paul M. Ridker, M.D., Nader Rifai, Ph.D., Lynda Rose, M.S., Julie E. Buring, Sc.D., and Nancy R. Cook, Sc.D.
ABSTRACT
Background Both C-reactive protein and low-density lipoprotein
(LDL) cholesterol levels are elevated in persons at risk for cardiovascular
events. However, population-based data directly comparing these two
biologic markers are not available.
Methods C-reactive protein and LDL cholesterol were measured at base
line in 27,939 apparently healthy American women, who were then
followed for a mean of eight years for the occurrence of myocardial
infarction, ischemic stroke, coronary revascularization, or death
from cardiovascular causes. We assessed the value of these two
measurements in predicting the risk of cardiovascular events in the
study population.
Results Although C-reactive protein and LDL cholesterol were minimally
correlated (r=0.08), base-line levels of each had a strong linear
relation with the incidence of cardiovascular events. After
adjustment for age, smoking status, the presence or absence of
diabetes mellitus, categorical levels of blood pressure, and use or
nonuse of hormone-replacement therapy, the relative risks of first
cardiovascular events according to increasing quintiles of
C-reactive protein, as compared with the women in the lowest
quintile, were 1.4, 1.6, 2.0, and 2.3 (P<0.001), whereas the
corresponding relative risks in increasing quintiles of LDL
cholesterol, as compared with the lowest, were 0.9, 1.1, 1.3, and
1.5 (P<0.001). Similar effects were observed in separate analyses
of each component of the composite end point and among users and
nonusers of hormone-replacement therapy. Overall, 77 percent of all
events occurred among women with LDL cholesterol levels below 160 mg
per deciliter (4.14 mmol per liter), and 46 percent occurred among
those with LDL cholesterol levels below 130 mg per deciliter (3.36
mmol per liter). By contrast, because C-reactive protein and LDL
cholesterol measurements tended to identify different high-risk
groups, screening for both biologic markers provided better
prognostic information than screening for either alone. Independent
effects were also observed for C-reactive protein in analyses
adjusted for all components of the
Conclusions These data suggest that the C-reactive protein level
is a stronger predictor of cardiovascular events than the LDL cholesterol
level and that it adds prognostic information to that conveyed by
the
Source Information
From the Center for Cardiovascular Disease
Prevention and the Divisions of Preventive Medicine (P.M.R., L.R., J.E.B., N.R.C.)
and Cardiology (P.M.R.), Brigham and Women's Hospital and
Address reprint requests to Dr. Ridker at the
Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital,
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