This study examined the role of various inflammatory biomarkers in predicting coronary heart disease (CHD) among healthy subjects considered as being at intermediate risk (according to the Framingham Risk Score (FRS)) in the EPIC-Norfolk prospective population. Markers considered the C-reactive protein (CRP), myeloperoxidase (MPO), paraoxonase (PON), secretory phospholipase A2 group IIA (sPLA2), lipoprotein-associated phospholipase A2 (Lp-PLA2), fibrinogen, macrophage chemoattractant protein-1 (MCP-1) and adiponectin. The highest c statistics were observed for FRS plus CRP (0.61, 95% CI 0.57 to 0.65) in the intermediate risk subgroup of participants. CRP also showed a net corrected reclassification of cases and controls of 12% across the entire risk spectrum and of 28.4% in the intermediate-risk group. The discriminatory potential of inflammatory biomarkers was substantially different when analysed across the entire risk spectrum compared to the subgroup of people at intermediate risk. In this study, CRP combined to the FRS was found to provide the most accurate equation to predict future CHD among participants at intermediate CHD risk when compared to the FRS alone, which is based on established risk factors only.
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