This paper from the well-known Framingham Heart Study Offspring cohort investigated the long-term intra-individual variability of C-reactive protein (CRP), determinants of changes, and the ability of CRP to predict the presence of the metabolic syndrome and new-onset diabetes. In this cohort, 2,409 patients had 3 measurements of CRP taken using the same methodology over up to 20 years (0, 16, and 20 years). Between the first two evaluations (separated by 16 years), 23% to 47% of men and 27% to 49% of women remained within the same quintile of CRP. Moreover, 24% to 51% of men and 24% to 50% of women were in an adjacent quintile. A similar pattern was observed for the intermediate term (4 years). Another analysis demonstrated that the variability of CRP, either during the long term or intermediate term, was significantly less than that of total cholesterol. After adjusting for variables known to affect CRP levels, it was found that CRP level at the first evaluation contributed the bulk of the variability at the second evaluation 16 years later. Finally, although CRP during the intermediate term (4 years) did not predict metabolic syndrome at the last evaluation, it did predict new-onset diabetes.
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