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John Danesh a Clinical Trial
Service Unit and Epidemiological Studies Unit, University of Oxford,
Radcliffe Infirmary, Oxford OX2 6HE, b Department of Public Health
Sciences, St George's Hospital Medical School, London SW17 0RE, c Departments of
Medicine and Population Sciences and Primary Care, Royal Free and
University College Medical School, London NW3 2PF, d Imperial
Cancer Research Fund Cancer Epidemiology Unit, Oxford OX2 6HE
Correspondence to:
J Danesh
Objective:
To assess associations between baseline
values of four different circulating markers of inflammation and future risk of coronary heart disease, potential triggers of systemic inflammation (such as persistent infection), and other markers of inflammation.
Design:
Nested case-control comparisons in a
prospective, population based cohort.
Setting:
General practices in 18 towns in Britain.
Participants:
506 men who died from coronary heart
disease or had a non-fatal myocardial infarction and 1025 men who
remained free of such disease until 1996 selected from 5661 men aged
40-59 years who provided blood samples in 1978-1980.
Main outcome measures:
Plasma concentrations of C
reactive protein, serum amyloid A protein, and serum albumin and
leucocyte count. Information on fatal and non-fatal coronary heart
disease was obtained from medical records and death certificates.
Results:
Compared with men in the bottom third of
baseline measurements of C reactive protein, men in the top third had
an odds ratio for coronary heart disease of 2.13 (95% confidence interval 1.38 to 3.28) after age, town, smoking, vascular risk factors,
and indicators of socioeconomic status were adjusted for. Similar
adjusted odds ratios were 1.65 (1.07 to 2.55) for serum amyloid A
protein; 1.12 (0.71 to 1.77) for leucocyte count; and 0.67 (0.43 to
1.04) for albumin. No strong associations were observed of these
factors with Helicobacter pylori seropositivity, Chlamydia pneumoniae IgG titres, or plasma total
homocysteine concentrations. Baseline values of the acute phase
reactants were significantly associated with one another (P<0.0001),
although the association between low serum albumin concentration and
leucocyte count was weaker (P=0.08).
Conclusion:
In the context of results from other
relevant studies these findings suggest that some inflammatory
processes, unrelated to the chronic infections studied here, are likely
to be involved in coronary heart disease.
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