Relation of C-Reactive Protein and Coronary Heart Disease in the MRFIT Nested Case-Control Study

TLDR

This prospective study in high‑risk but otherwise healthy individuals first documents a link between C‑reactive protein levels and coronary heart disease mortality. The authors conducted a nested case‑control study within the MRFIT cohort, measuring CRP, α1‑acid glycoprotein, and albumin in 98 MI cases, 148 CHD deaths, and 491 controls, with follow‑up of up to 17 years for deaths and 6–7 years for MI events. Higher CRP levels were significantly associated with increased coronary heart disease mortality, especially among smokers (hazard ratio 4.3 for the highest versus lowest quartile), and this association remained after adjustment for smoking and pulmonary function; α1‑acid glycoprotein showed no relation, while albumin was inversely related only to deaths occurring 7–13 years after baseline. Am J Epidemiol 1996; 144:537–47.

Abstract

The authors measured the relation between C-reactive protein, α1 acid glycoprotein and albumin, an acute phase protein, and subsequent risk of myocardial infarction and coronary heart disease death in a nested case-control study among the Multiple Risk Factor Intervention Trial (MRFIT) participants. There were 98 myocardial infarction cases, 148 coronary heart disease deaths, and 491 controls. The cases and controls were followed for up to 17 years for deaths and 6–7 years for myocardial infarction cases and controls. There was a significant association between available distribution of C-reactive protein and subsequent coronary heart disease mortality. For smokers at baseline, the risk of coronary heart disease deaths in quartile 4 of C-reactive protein as compared with quartile 1 was 4.3 (95% confidence interval 1.74–10.8). The association persisted when adjusted for characteristics related to smoking and smoking cessation during the trial and to pulmonary function. There was no relation between α1 acid glycoprotein and either myocardial infarction or coronary heart disease death. Albumin was inversely related to coronary heart disease death only for deaths that occurred between 7 and 13 years after baseline, consistent with previous MRFIT analyses. This is the first prospective study in "healthy but high risk individuals" to document the relation between C-reactive protein and coronary heart disease mortality. Am J Epidemiol 996; 144: 537–47.