C Reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study

BMJ 1996; 312 doi: (Published 27 April 1996) Cite this as: BMJ 1996;312:1061
  1. M A Mendall, senior lecturera,
  2. Praful Patel, research fellowa,
  3. Lydia Ballam, research assistanta,
  4. D Strachan, senior lecturerb,
  5. T C Northfield, professora
  1. a Division of Biochemical Medicine, St George's Medical School, London SW17 0RE
  2. b Public Health Sciences, St George's Medical School, London SW17 0RE
  1. Correspondence to: Dr Mendall.
  • Accepted 13 February 1996


Objective: To test the hypothesis that minor chronic insults such as smoking, chronic bronchitis, and two persistent bacterial infections may be associated with increases in C reactive protein concentration within the normal range and that variations in the C reactive protein concentration in turn may be associated with levels of cardiovascular risk factors and chronic coronary heart disease.

Design: Population based cross sectional study.

Setting: General practices in Merton, Sutton, and Wandsworth.

Subjects: A random sample of 388 men aged 50-69 years from general practice registers. 612 men were invited to attend and 413 attended, of whom 25 non-white men were excluded. The first 303 of the remaining 388 men had full risk factor profiles determined.

Interventions: Measurements of serum C reactive protein concentrations by in house enzyme linked immunosorbent assay (ELISA); other determinations by standard methods. Coronary heart disease was sought by the Rose angina questionnaire and Minnesota coded electrocardiograms.

Main outcome measures: Serum C reactive protein concentrations, cardiovascular risk factor levels, and the presence of coronary heart disease.

Results: Increasing age, smoking, symptoms of chronic bronchitis, Helicobacter pylori and Chlamydia pneumoniae infections, and body mass index were all associated with raised concentrations of C reactive protein. C Reactive protein concentration was associated with raised serum fibrinogen, sialic acid, total cholesterol, triglyceride, glucose, and apolipoprotein B values. C Reactive protein concentration was negatively associated with high density lipoprotein cholesterol concentration. There was a weaker positive relation with low density lipoprotein cholesterol concentration and no relation with apolipoprotein A I value. C Reactive protein concentration was also strongly associated with coronary heart disease.

Conclusion: The body's response to inflammation may play an important part in influencing the progression of atherosclerosis. The association of C reactive protein concentration with coronary heart disease needs testing in prospective studies.

Key messages

  • Factors that determine levels of inflammatory mediators in the normal general population have not been explored, nor has their relation to cardio- vascular risk factors

  • Among 50-69 year old men many environmental and lifestyle risk factors for cardiovascular disease are associated with raised serum concentrations of C reactive protein

  • Circulating concentrations of lipids, glucose, and clotting factors are also associated with serum C reactive protein concentrations

  • The body's response to inflammation may influence the development of atherosclerosis


  • Funding British Heart Foundation.

  • Conflict of interest None.

  • Accepted 13 February 1996
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