@article {1151, title = {C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis.}, journal = {Lancet}, volume = {375}, year = {2010}, month = {2010 Jan 09}, pages = {132-40}, abstract = {

BACKGROUND: Associations of C-reactive protein (CRP) concentration with risk of major diseases can best be assessed by long-term prospective follow-up of large numbers of people. We assessed the associations of CRP concentration with risk of vascular and non-vascular outcomes under different circumstances.

METHODS: We meta-analysed individual records of 160 309 people without a history of vascular disease (ie, 1.31 million person-years at risk, 27 769 fatal or non-fatal disease outcomes) from 54 long-term prospective studies. Within-study regression analyses were adjusted for within-person variation in risk factor levels.

RESULTS: Log(e) CRP concentration was linearly associated with several conventional risk factors and inflammatory markers, and nearly log-linearly with the risk of ischaemic vascular disease and non-vascular mortality. Risk ratios (RRs) for coronary heart disease per 1-SD higher log(e) CRP concentration (three-fold higher) were 1.63 (95\% CI 1.51-1.76) when initially adjusted for age and sex only, and 1.37 (1.27-1.48) when adjusted further for conventional risk factors; 1.44 (1.32-1.57) and 1.27 (1.15-1.40) for ischaemic stroke; 1.71 (1.53-1.91) and 1.55 (1.37-1.76) for vascular mortality; and 1.55 (1.41-1.69) and 1.54 (1.40-1.68) for non-vascular mortality. RRs were largely unchanged after exclusion of smokers or initial follow-up. After further adjustment for fibrinogen, the corresponding RRs were 1.23 (1.07-1.42) for coronary heart disease; 1.32 (1.18-1.49) for ischaemic stroke; 1.34 (1.18-1.52) for vascular mortality; and 1.34 (1.20-1.50) for non-vascular mortality.

INTERPRETATION: CRP concentration has continuous associations with the risk of coronary heart disease, ischaemic stroke, vascular mortality, and death from several cancers and lung disease that are each of broadly similar size. The relevance of CRP to such a range of disorders is unclear. Associations with ischaemic vascular disease depend considerably on conventional risk factors and other markers of inflammation.

FUNDING: British Heart Foundation, UK Medical Research Council, BUPA Foundation, and GlaxoSmithKline.

}, keywords = {Alcohol Drinking, Biomarkers, Blood Pressure, Body Mass Index, C-Reactive Protein, Cholesterol, Coronary Disease, Databases, Factual, Diabetes Mellitus, Female, Fibrinogen, Humans, Interleukin-6, Leukocyte Count, Lung Diseases, Male, Middle Aged, Motor Activity, Neoplasms, Regression Analysis, Risk Assessment, Risk Factors, Serum Albumin, Sex Factors, Smoking, Stroke, Triglycerides}, issn = {1474-547X}, doi = {10.1016/S0140-6736(09)61717-7}, author = {Kaptoge, Stephen and Di Angelantonio, Emanuele and Lowe, Gordon and Pepys, Mark B and Thompson, Simon G and Collins, Rory and Danesh, John} } @article {1563, title = {Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies.}, journal = {Lancet}, volume = {377}, year = {2011}, month = {2011 Mar 26}, pages = {1085-95}, abstract = {

BACKGROUND: Guidelines differ about the value of assessment of adiposity measures for cardiovascular disease risk prediction when information is available for other risk factors. We studied the separate and combined associations of body-mass index (BMI), waist circumference, and waist-to-hip ratio with risk of first-onset cardiovascular disease.

METHODS: We used individual records from 58 cohorts to calculate hazard ratios (HRs) per 1 SD higher baseline values (4.56 kg/m(2) higher BMI, 12.6 cm higher waist circumference, and 0.083 higher waist-to-hip ratio) and measures of risk discrimination and reclassification. Serial adiposity assessments were used to calculate regression dilution ratios.

RESULTS: Individual records were available for 221,934 people in 17 countries (14,297 incident cardiovascular disease outcomes; 1.87 million person-years at risk). Serial adiposity assessments were made in up to 63,821 people (mean interval 5.7 years [SD 3.9]). In people with BMI of 20 kg/m(2) or higher, HRs for cardiovascular disease were 1.23 (95\% CI 1.17-1.29) with BMI, 1.27 (1.20-1.33) with waist circumference, and 1.25 (1.19-1.31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After further adjustment for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding HRs were 1.07 (1.03-1.11) with BMI, 1.10 (1.05-1.14) with waist circumference, and 1.12 (1.08-1.15) with waist-to-hip ratio. Addition of information on BMI, waist circumference, or waist-to-hip ratio to a cardiovascular disease risk prediction model containing conventional risk factors did not importantly improve risk discrimination (C-index changes of -0.0001, -0.0001, and 0.0008, respectively), nor classification of participants to categories of predicted 10-year risk (net reclassification improvement -0.19\%, -0.05\%, and -0.05\%, respectively). Findings were similar when adiposity measures were considered in combination. Reproducibility was greater for BMI (regression dilution ratio 0.95, 95\% CI 0.93-0.97) than for waist circumference (0.86, 0.83-0.89) or waist-to-hip ratio (0.63, 0.57-0.70).

INTERPRETATION: BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.

FUNDING: British Heart Foundation and UK Medical Research Council.

}, keywords = {Age Factors, Blood Pressure, Body Mass Index, Cardiovascular Diseases, Cholesterol, Cholesterol, HDL, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Obesity, Abdominal, Proportional Hazards Models, Prospective Studies, Risk Assessment, Sex Factors, Smoking, Systole, Waist Circumference, Waist-Hip Ratio}, issn = {1474-547X}, doi = {10.1016/S0140-6736(11)60105-0}, author = {Wormser, David and Kaptoge, Stephen and Di Angelantonio, Emanuele and Wood, Angela M and Pennells, Lisa and Thompson, Alex and Sarwar, Nadeem and Kizer, Jorge R and Lawlor, Debbie A and Nordestgaard, B{\o}rge G and Ridker, Paul and Salomaa, Veikko and Stevens, June and Woodward, Mark and Sattar, Naveed and Collins, Rory and Thompson, Simon G and Whitlock, Gary and Danesh, John} }