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C-reactive protein (CRP) and fibrinogen have both been proposed as predictors of cardiovascular risk in asymptomatic individuals. In this analysis, investigators from the Emerging Risk Factors Collaboration examined data from 52 studies to assess how much the addition of these newer risk factors improve standard risk prediction and to model the likely preventive effect of systematic testing.
When added to a base model including age, sex, smoking status, history of diabetes, blood pressure, and cholesterol, inclusion of CRP resulted in an improvement of 1.52% in the net reclassification of individuals into low (<10%), intermediate (10% to <20%) and high (≥20%) 10-year risk for events. Fibrinogen testing was associated with a slightly smaller improvement in net reclassification (0.83%). Based on these data, the authors estimate that assessing CRP in individuals at intermediate risk would help prevent 1 event over 10 years for every 440 people screened; the corresponding estimate for fibrinogen was 1 event for every 490 screened.
The Emerging Risk Factors Collaboration. C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med 2012 Oct 4; 367:1310.
Comment
This analysis suggests that both CRP and fibrinogen can improve risk prediction, but the incremental gains are modest. As the authors acknowledge, several important questions remain unanswered, such as how these serum markers compare with other serum markers and with imaging markers such as calcium scoring (JW Gen Med Sep 27 2012) with regard to both effectiveness and cost.