Relation between C-reactive protein, homocysteine levels, fibrinogen, and lipoprotein levels and leukocyte and platelet counts, and 10-year risk for cardiovascular disease among healthy adults in the USA

Abstract

The association between systemic inflammation and the estimated 10-year risk for coronary artery disease (CAD) according to the Framingham risk score is largely unknown. In this study, 6,371 participants in the Third National Health and Nutrition Examination Survey (NHANES III) aged 40 to 79 years, who had no histories of heart attack, stroke, peripheral artery disease, or diabetes mellitus, were categorized into groups at low (<10%), intermediate (10% to 20%), and high (>20%) risk according to 10-year risk for CAD, calculated using the Framingham risk score modified by the National Cholesterol Education Program Adult Treatment Panel III. After adjustments for age, gender, race, body mass index, and co-morbidities, participants at high risk were more likely to have elevated circulating C-reactive protein levels (>/=2.2 mg/L: adjusted odds ratio [OR] 1.61, 95% confidence interval [CI] 1.30 to 2.01, p <0.0001; >10.0 mg/L: OR 1.41, 95% CI 1.03 to 1.93, p = 0.034). The high-risk group had circulating fibrinogen, homocysteine, leukocyte, and platelet levels that were 20.98 mg/dl (95% CI 12.53 to 29.43, p <0.0001), 1.54 mumol/L (95% CI 0.76 to 2.32, p = 0.002), 0.90 mumol/L (95% CI 0.36 to 1.43, p = 0.001), 910/microl (95% CI 670 to 1,160, p <0.0001), and 10,220/microl (95% CI 2,830 to 17,610, p <0.0001) higher, respectively, than in those in the low-risk group. There was also a dose-dependent increase in circulating levels of inflammatory markers across the categories of CAD risk. In conclusion, these findings indicate that low-grade systemic inflammation and hyperhomocysteinemia were present in participants with high 10-year risk for CAD.