The addition of the measurement of C-reactive protein to screening based on lipid levels may provide an improved method of identifying persons at risk for cardiovascular events.

Elevated levels of CRP and IL-6 predict the development of type 2 DM. These data support a possible role for inflammation in diabetogenesis.

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 Framingham risk score.

Existing knowledge of genetic variants affecting risk of coronary artery disease (CAD) is largely based on genome-wide association studies (GWAS) analysis of common SNPs. Leveraging phased haplotypes from the 1000 Genomes Project, we report a GWAS meta-analysis of 185 thousand CAD cases and controls, interrogating 6.7 million common (MAF>0.05) as well as 2.7 million low frequency (0.005

In this large, primary-prevention trial among women, aspirin lowered the risk of stroke without affecting the risk of myocardial infarction or death from cardiovascular causes, leading to a nonsignificant finding with respect to the primary end point.

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Context Despite improved understanding of atherothrombosis, cardiovascular prediction algorithms for women have largely relied on traditional risk factors. Objective To develop and validate cardiovascular risk algorithms for women based on a large panel of traditional and novel risk factors. Design, Setting, and Participants Thirty-five factors were assessed among 24 558 initially healthy US women 45 years or older who were followed up for a median of 10.2 years (through March 2004) for incident cardiovascular events (an adjudicated composite of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death). We used data among a random two thirds (derivation cohort, n = 16 400) to develop new risk algorithms that were then tested to compare observed and predicted outcomes in the remaining one third of women (validation cohort, n=8158). Main Outcome Measure Minimization of the Bayes Information Criterion was used in the derivation cohort to develop the best-fitting parsimonious prediction models. In the validation cohort, we compared predicted vs actual 10-year cardiovascular event rates when the new algorithms were compared with models based on covariates included in the Adult Treatment Panel III risk score. Results In the derivation cohort, a best-fitting model (model A) and a clinically simplified model (model B, the Reynolds Risk Score) had lower Bayes Information Criterion scores than models based on covariates used in Adult Treatment Panel III. In the validation cohort, all measures of fit, discrimination, and calibration were improved when either model A or B was used. For example, among participants without diabetes with estimated 10year risks according to the Adult Treatment Panel III of 5% to less than 10% (n=603) or 10% to less than 20% (n=156), model A reclassified 379 (50%) into higher-or lowerrisk categories that in each instance more accurately matched actual event rates. Similar effects were achieved for clinically simplified model B limited to age, systolic blood pressure, hemoglobin A 1c if diabetic, smoking, total and high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and parental history of myocardial infarction before age 60 years. Neither new algorithm provided substantive information about women at very low risk based on the published Adult Treatment Panel III score. Conclusion We developed, validated, and demonstrated highly improved accuracy of 2 clinical algorithms for global cardiovascular risk prediction that reclassified 40% to 50% of women at intermediate risk into higher-or lower-risk categories.

N CONTRAST TO TOTAL CHOLESterol, low-density lipoprotein cholesterol (LDL-C), and highdensity lipoprotein cholesterol (HDL-C), which are well-established independent risk factors for cardiovascular disease, 1 the importance of triglycerides remains controversial. In part this controversy reflects the fact that, due to the inverse correlation of triglyceride levels with those of HDL-C, adjustment for HDL-C attenuates the relationship between triglycerides and cardiovascular disease. A recent metaanalysis suggested that the adjusted risk ratio for coronary heart disease among individuals in the highest third of triglyceride levels compared with those in the lowest third decreases from approximately 2.0 to 1.5 after accounting for HDL-C levels. 2 A second aspect of the controversy stems from the manner in which triglyceride levels are typically measured. Current national guidelines recommend that blood for lipid profiles be drawn after an 8-to 12-hour fast. 1 Because plasma triglyceride levels can increase substantially postprandially, fasting levels ostensibly avoid the variability associated with meals and provide a See also pp 299 and 336.