October 1, 2002Arteriosclerosis Thrombosis and Vascular Biology240 citationsOpen Access
View Full PaperAssociation of C-Reactive Protein With Carotid Atherosclerosis in Men and Women: The Framingham Heart Study
Key Result
Elevated C-reactive protein (fourth vs lowest quartile) was independently associated with a higher risk of carotid stenosis in women (OR 2.97; 95% CI 1.72-5.25) but not in men.
Study Design
Type
Cohort (n=3,173)
Structured PICO
Is elevated C-reactive protein associated with an increased risk of carotid atherosclerosis in men and women?
P
Population
3,173 subjects in the offspring cohort of the Framingham Heart Study, mean age 55, 52% women
I
Intervention
Elevated C-reactive protein (CRP) levels (fourth quartile)
C
Comparator
Lowest quartile of C-reactive protein (CRP)
O
Outcome
Carotid stenosis (≥25%) and internal carotid intima-media thickness assessed by carotid ultrasonography at 4 yearssurrogate
Elevated CRP is independently associated with carotid atherosclerosis in women but not in men, suggesting potential sex differences in the inflammatory mechanisms of atherosclerosis.
Main Result
Effect estimate: OR 2.97 (95% CI 1.72 to 5.25)
Abstract
OBJECTIVE: The objective of this study was to examine the relationship between C-reactive protein (CRP) and carotid atherosclerosis. BACKGROUND: Levels of CRP, a nonspecific marker of inflammation, predict risk for cardiovascular events. However, the association between CRP and direct measures of atherosclerosis is not well established. METHODS AND RESULTS: Subjects (n=3173, 52% women, mean age 55) in the offspring cohort of the Framingham Heart Study received a CRP measurement and then underwent carotid ultrasonography 4 years later. Carotid stenosis (> or =25%) was present in 24% of men and 14% of women. Age-adjusted odds ratios for carotid stenosis were 1.62 (95%CI 1.12 to 2.36) for men and 3.90 (CI 2.44 to 6.44) for women in the fourth quartile of CRP compared with those in the lowest quartile. After further adjustment for traditional cardiovascular disease risk factors, the odds ratio remained significant for women (2.97, CI 1.72 to 5.25) but not for men. Similarly, after multivariable adjustment, women in the fourth CRP quartile had a higher mean internal carotid intima-media thickness than those in the lowest CRP quartile (P< or =0.001). There was no association between common carotid intima-media thickness and CRP. CONCLUSIONS: There is a graded association between CRP and carotid atherosclerosis in women but not in men. The significance of this difference between sexes merits further investigation.