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Abstract
Atherosclerosis is an inflammatory disease. C-reactive protein (CRP), a marker of
inflammation, is associated with coronary heart disease (CHD). We measured CRP in
a cohort of 247 patients (193 males and 54 females) who had had their first myocardial
infarction (MI) at age < or = 55 (males) or < or = 60 (females). The cut-off values
of the 25th, 50th and 75th centiles of CRP were 1.20, 2.37 and 4.20 mg/l. After 10
years, a total of 44 patients (17.8%) had died, 36 (81.8%) of cardiac causes. Unadjusted
and adjusted (i.e. for age, ejection fraction (EF), serum total cholesterol (TC),
fibrinogen, smoking and hypertension) relative risks (RRs) for total and cardiac mortality
were generated. CRP was a strong predictor of death of all causes due to its strength
as predictor of cardiac death. The RR of cardiac death was doubled with increasing
CRP quartiles, and patients in the top quartile had six times as high risk of cardiac
death as patients in the lowest quartile. The RRs were moderately attenuated after
adjustment, but still significant. We conclude that CRP is a strong predictor of mortality
in patients with premature MI. Thus, inflammation appears to be a critical prognostic
factor in patients with previous premature MI.