Study: C-Reactive Protein And The Cholesterol To HDL-Cholesterol Ratio Are The Strongest Independent Predictors Of Development Of Peripheral Arterial Disease

Some recent studies claim that the use of lab tests like C-Reactive Protein as a general screening tool add little information to that already provided by cholesterol levels, blood pressure and lifestyle issues, such as smoking patterns. But as a specific predictive tool C-Reactive Protein in combination with the Cholesterol to HDL-Cholesterol ratio have not been surpassed.

Michael's Note:
I have been having asked my doctor to include CRP tests when I get my tests done for several years. My CRP measures at the very bottom of the scale, indicating that there is very little inflammation in my body. Coupled with my blood lipid tests, like the ratio of cholesterol to HDL-Cholesterol, this indicates that there is very little potential that I have peripheral arterial disease. This was confirmed by an Ultra-fast CT scan I had done a in 1999 and one I had done in 2007.

Novel risk factors for systemic atherosclerosis:
A comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease.
JAMA. 2001 May 16;285(19):2481-5 Ridker PM, Stampfer MJ, Rifai N.

CONTEXT: Several novel risk factors for atherosclerosis have recently been proposed, but few comparative data exist to guide clinical use of these emerging biomarkers.

OBJECTIVE: To compare the predictive value of 11 lipid and nonlipid biomarkers as risk factors for development of symptomatic peripheral arterial disease (PAD).

DESIGN, SETTING, AND PARTICIPANTS: Nested case-control study using plasma samples collected at baseline from a prospective cohort of 14,916 initially healthy US male physicians aged 40 to 84 years, of whom 140 subsequently developed symptomatic PAD (cases); 140 age- and smoking status-matched men who remained free of vascular disease during an average 9-year follow-up period were randomly selected as controls.

MAIN OUTCOME MEASURE: Incident PAD, as determined by baseline total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol-HDL-C ratio, triglycerides, homocysteine, C-reactive protein (CRP), lipoprotein(a), fibrinogen, and apolipoproteins (apo) A-I and B-100.

RESULTS: In univariate analyses, plasma levels of total cholesterol (P<.001), LDL-C (P =.001), triglycerides (P =.001), apo B-100 (P =.001), fibrinogen (P =.02), CRP (P =.006), and the total cholesterol-HDL-C ratio (P<.001) were all significantly higher at baseline among men who subsequently developed PAD compared with those who did not, while levels of HDL-C (P =.009) and apo A-I (P =.05) were lower. Nonsignificant baseline elevations of lipoprotein(a) (P =.40) and homocysteine (P =.90) were observed. In multivariable analyses, the total cholesterol-HDL-C ratio was the strongest lipid predictor of risk (relative risk [RR] for those in the highest vs lowest quartile, 3.9; 95% confidence interval [CI], 1.7-8.6), while CRP was the strongest nonlipid predictor (RR for the highest vs lowest quartile, 2.8; 95% CI, 1.3-5.9). In assessing joint effects, addition of CRP to standard lipid screening significantly improved risk prediction models based on lipid screening alone (P<.001).

CONCLUSIONS: Of 11 atherothrombotic biomarkers assessed at baseline, the total cholesterol-HDL-C ratio and CRP were the strongest independent predictors of development of peripheral arterial disease. C-reactive protein provided additive prognostic information over standard lipid measures.