Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events

Abstract-An altered hormonal or chronic systemic inflammatory milieu characterizing endometriosis may result in a higher risk of hypercholesterolemia and hypertension. Conversely, elevated low-density lipoprotein in hypercholesterolemia and chronic systemic inflammation resulting from hypertension may increase the risk of endometriosis. We assessed the association of laparoscopically confirmed endometriosis with hypercholesterolemia and hypertension in a large prospective cohort study. In 1989, 116 430 registered female nurses aged 25 to 42 completed the baseline questionnaire and were followed for 20 years. Multivariable Cox proportional hazards models were applied. In 1989, there were 4244 women with laparoscopically confirmed endometriosis and 91 554 women without. After adjusting for demographic, anthropometric, family history, reproductive, dietary, and lifestyle risk factors prospectively, comparing women with laparoscopically confirmed endometriosis to women without, the relative risks were 1.25 (95% confidence interval, 1.21-1.30) for development of hypercholesterolemia and 1.14 (95% confidence interval, 1.09-1.18) for hypertension. Conversely, the relative risks of developing laparoscopically confirmed endometriosis were 1.22 (95% confidence interval, 1.15-1.31) comparing women with hypercholesterolemia to women without and 1.29 (95% confidence interval, 1.18-1.41) comparing women with hypertension to women without. The strength of associations of laparoscopically confirmed endometriosis with hypercholesterolemia or hypertension was strongest among women aged ≤40 and weakened as age increased (P values for interaction <0.001). We observed that ≈45% of the associations between endometriosis and hypercholesterolemia and hypertension could be accounted for by treatment factors after endometriosis diagnosis, including greater frequency of hysterectomy/oophorectomy and earlier age for this surgery. In this large cohort study, laparoscopically confirmed endometriosis was prospectively associated with increased risk of hypercholesterolemia and hypertension. Conversely, hypercholesterolemia and hypertension were prospectively associated with higher risk of laparoscopically confirmed endometriosis. process, which may be contributing to blood pressure elevation. 23 Hence the chronic systemic inflammation in endometriosis may predispose women with endometriosis to a higher risk of hypertension.In sum, women with endometriosis may have higher risk of hypercholesterolemia or hypertension, and women with hypertension or hypercholesterolemia may have a higher risk of endometriosis. We examined these hypotheses in the NHSII (Nurses' Health Study II), an ongoing prospective cohort study. Methods Study PopulationThe NHSII is a prospective cohort study with 116 430 registered female nurses who were 25 to 42 and resided in 14 of the United States at enrollment in 1989. At baseline, participants completed a detailed questionnaire and every 2 years thereafter completed follow-up questionnaires on the incidence of disease out...

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“…36,37 In addition, the association observed between endometriosis and hypercholesterolemia was consistent with earlier casecontrol studies.…”

Section: Analysis 2: Hypercholesterolemia or Hypertension In Relationsupporting

confidence: 90%

Association Between Endometriosis and Hypercholesterolemia or Hypertension

Rich‐Edwards

Rimm

et al. 2017

Hypertension

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“…CRP is a marker for inflammation (40) and may also play a role in the inflammatory process (41,42). This may explain why CRP is a strong predictor of cardiovascular events such as myocardial infarction (28). The present findings of very low plasma insulin and serum platelet-derived growth factor levels in the CR group provide preliminary evidence that CR also results in a decreased stimulus for cell proliferation in humans.…”

Section: Discussionmentioning

confidence: 53%

Long-term calorie restriction is highly effective in reducing the risk for atherosclerosis in humans

Fontana

Meyer

Klein

et al. 2004

Proc. Natl. Acad. Sci. U.S.A.

789

616

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Little is known regarding the long-term effects of caloric restriction (CR) on the risk for atherosclerosis. We evaluated the effect of CR on risk factors for atherosclerosis in individuals who are restricting food intake to slow aging. We studied 18 individuals who had been on CR for an average of 6 years and 18 age-matched healthy individuals on typical American diets. We measured serum lipids and lipoproteins, fasting plasma glucose and insulin, blood pressure (BP), high-sensitivity C-reactive protein (CRP), platelet-derived growth factor AB (PDGF-AB), body composition, and carotid artery intima-media thickness (IMT). The CR group were leaner than the comparison group (body mass index, 19.6 ؎ 1.9 vs. 25.9 ؎ 3.2 kg͞m 2 ; percent body fat, 8.7 ؎ 7% vs. 24 ؎ 8%). Serum total cholesterol (Tchol), low-density lipoprotein cholesterol, ratio of Tchol to high-density lipoprotein cholesterol (HDL-C), triglycerides, fasting glucose, fasting insulin, CRP, PDFG-AB, and systolic and diastolic BP were all markedly lower, whereas HDL-C was higher, in the CR than in the American diet group. Medical records indicated that the CR group had serum lipid-lipoprotein and BP levels in the usual range for individuals on typical American diets, and similar to those of the comparison group, before they began CR. Carotid artery IMT was Ϸ40% less in the CR group than in the comparison group. Based on a range of risk factors, it appears that long-term CR has a powerful protective effect against atherosclerosis. This interpretation is supported by the finding of a low carotid artery IMT.

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“…Previous studies linking CRP levels to CHD were performed largely in populations with a lower prevalence of obesity than that of the current US population 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32. In the 2 largest published studies of CRP and CHD disease,25, 27 the mean body mass index (in kg/m 2 ) of participants ranged from 25 to 26, lower than the recently reported mean of 28.7 in US adults,33 indicating the clinical need for data regarding CRP in obese populations. The Strong Heart Study examined the relationship between CRP levels and CHD in an obese population with a mean body mass index >30 34.…”

Section: Discussionmentioning

confidence: 99%

C‐Reactive Protein Identifies Low‐Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer–Norfolk Prospective Population Study

Wijk

Boekholdt

Arsenault

et al. 2016

JAHA

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BackgroundConflicting data exist about the cardiovascular risk of metabolically healthy obese persons. The prognostic value of C‐reactive protein (CRP) in this intriguing group is unknown. We assessed the association between CRP levels and the risk of coronary heart disease (CHD) in metabolically healthy persons with abdominal obesity.Methods and ResultsIn the European Prospective Investigation of Cancer–Norfolk prospective cohort, CRP levels and information on metabolic syndrome criteria were available for 7279 participants, of whom 825 (11%) developed CHD during a follow‐up period of 10.9±1.8 years. There was a trend toward a higher multivariable‐adjusted hazard ratio for CHD in metabolically healthy obese participants with CRP levels >2 mg/L compared with <2 mg/L (hazard ratio 1.59, 95% CI 0.97–2.62, P=0.066). Metabolically unhealthy obese participants had significantly higher CHD risk compared with metabolically healthy obese participants with CRP levels <2 mg/L (hazard ratio 1.88, 95% CI 1.20–2.94, P=0.006). Most important, we found that the risk of CHD among metabolically healthy obese persons with CRP levels <2 mg/L was comparable to that of metabolically healthy nonobese persons (hazard ratio 0.91, 95% CI 0.60–1.39, P=0.674).ConclusionsAmong metabolically healthy obese persons, low CRP levels were associated with a CHD risk comparable to that of metabolically healthy nonobese persons. CRP appears to be an easy and widely available method for identifying a low‐risk subpopulation among metabolically healthy obese persons.

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Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events

Abstract: 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.

Cited by 3,123 publications

References 32 publications

Association Between Endometriosis and Hypercholesterolemia or Hypertension

Association Between Endometriosis and Hypercholesterolemia or Hypertension

Long-term calorie restriction is highly effective in reducing the risk for atherosclerosis in humans

C‐Reactive Protein Identifies Low‐Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer–Norfolk Prospective Population Study

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