CRP, LDL Cholesterol, and Lipoprotein(a) Levels Predictive of CVD

A single combined measure of high-sensitivity C-reactive protein (CRP), low-density lipoprotein (LDL) cholesterol, and lipoprotein(a) levels among initially healthy U.S. women predicted incident cardiovascular events over a 30-year period. High-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels were measured at baseline in 27,939 healthy U.S. women with mean age of 54.7 years. During the 30-year follow-up, there were 3662 first major adverse cardiovascular event (the primary end point, a composite of myocardial infarction, coronary revascularization, stroke, or death from cardiovascular causes). The 30-year risk rose with each quintile of high-sensitivity CRP and LDL cholesterol levels but was increased for lipoprotein(a) predominantly at the highest quintile. Covariable-adjusted hazard ratios for the primary end point in a comparison of the top with the bottom quintile were 1.70 for high-sensitivity CRP, 1.36 for LDL cholesterol, and 1.33 for lipoprotein(a). Findings for coronary heart disease and stroke appeared to be consistent with those for the primary end point. Each biomarker showed independent contributions to overall risk. The greatest spread for risk was obtained in models that incorporated all three biomarkers. The findings support the notion that adjunctive interventions addressing a diverse set of biologic targets may ultimately be needed for CVD. Source: https://www.nejm.org/