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Inflammatory biomarkers and the prediction of coronary events among people at intermediate risk; the EPIC-Norfolk prospective population study
  1. J S Rana
  1. Cedars-Sinai Medical Center, University of California Los Angeles, United States
    1. M Cote
    1. Québec Heart Institute, Hôpital Laval Research Centre, Québec, Canada
      1. J P Despres
      1. Québec Heart Institute, Hôpital Laval Research Centre, Québec, Canada
        1. M S Sandhu
        1. Institute of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
          1. P J Talmud
          1. Royal Free and University College Medical School, London, United Kingdom
            1. E Ninio
            1. UPMC Univ Paris 06 and Faculté de Médecine Pierre et Marie Curie, Paris, France
              1. N J Wareham
              1. MRC Epidemiology Unit, Cambridge, United Kingdom
                1. J J P Kastelein
                1. Academic Medical Center, Amsterdam, Netherlands
                  1. A H Zwinderman
                  1. Academic Medical Center, Amsterdam, Netherlands
                    1. K T Khaw
                    1. Institute of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
                      1. S M Boekholdt (s.m.boekholdt{at}amc.uva.nl)
                      1. Academic Medical Center, Amsterdam, Netherlands

                        Abstract

                        Objective: To evaluate the role of the inflammatory biomarkers C-reactive protein, (CRP), myeloperoxidase, paraoxonase, secretory phospholipase A2 group IIA (sPLA2), lipoprotein-associated phospholipase A2, fibrinogen, macrophage chemoattractant protein-1, and adiponectin, in predicting the risk of coronary heart disease (CHD) among individuals estimated to be at intermediate risk according to Framingham Risk Score (FRS).

                        Design: Prospective case-control study nested in EPIC-Norfolk cohort.

                        Setting: Norfolk, United Kingdom.

                        Patients: Apparently healthy men and women aged 45-79 years.

                        Main outcome measures: Risk of future coronary artery disease.

                        Results: For participants predicted to be at intermediate risk by the FRS, the highest c statistics were observed for FRS plus CRP (0.61, 95%CI 0.57 to 0.65) and for FRS plus sPLA2 (0.56, 95%CI 0.52 to 0.6). Net correct reclassification of cases and controls for each marker was assessed for people across the entire risk spectrum and again for people at intermediate risk only. The largest differences were observed for CRP, 12.0% net reclassification improvement in the entire risk spectrum and 28.4% net reclassification improvement in the intermediate risk group and for sPLA2, the net net reclassification improvement was 6.4% in the entire risk spectrum and 16.3% in the intermediate risk group.

                        Conclusions: The discriminatory potential of inflammatory biomarkers was substantially different when analyzed across the entire risk spectrum compared to the subgroup of people at intermediate risk.

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