C-reactive protein and microalbuminuria differ in their associations with various domains of vascular disease

  • Erik M. Stuveling
    Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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  • Hans L. Hillege
    Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
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  • Stephan J.L. Bakker
    Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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  • Folkert W. Asselbergs
    Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
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  • Paul E. de Jong
    Division of Nephrology, University Medical Centre Groningen, Groningen, The Netherlands
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  • Reinold O.B. Gans
    Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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  • Dick de Zeeuw
    Corresponding author. Tel.: +31-50-363-2810; fax: +31-50-363-2812.
    Department of Clinical Pharmacology, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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  • PREVEND study group
  • Author Footnotes
    1 The PREVEND study group consists of: P.E. de Jong, G.J. Navis, R.T. Gansevoort, J.C. Verhave, Division of Nephrology, Department of Medicine, University Medical Centre Groningen. D. de Zeeuw, W.H. van Gilst, R.H. Henning, Department of Clinical Pharmacology, University Medical Centre Groningen. R.O.B. Gans, S.J.L. Bakker, A.J. Smit, A.M. van Roon, E.M. Stuveling, Division of Vascular Medicine, Department of Medicine, University Medical Centre Groningen. D.J. van Veldhuisen, H.L. Hillege, A.J. van Boven, F.W. Asselbergs, C.P. Baljé-Volkers, Department of Cardiology, University Medical Centre Groningen. R.P.F. Dullaart, Division of Endocrinology, Department of Medicine, University Medical Centre Groningen. G.J. tc Meerman, G.-T. Spijker, Department of Medical Genetics, University Medical Centre Groningen. V. Fidler, J.G.M. Burgerhof, Department of Epidemiology and Statistics. LT.W. de Jong-van den Berg, M.J. Postma, J. van den Berg, Department of Phamaco-Epidemiology. J.H.J. Muntinga, Department of Medical Physiology. D.E. Grobbee, Department of Epidemiology, Julius Center, Utrecht.
    e1 [email protected]


      C-reactive protein (CRP) and microalbuminuria (MA) have been identified as risk markers for cardiovascular disease (CVD). We questioned whether CRP and MA are similar markers of vascular disease in different regions of the vascular tree like the heart, kidneys and extremities or if they differ in their relationships with these vascular beds. Baseline levels of CRP and urinary albumin were measured in 6669 non-diabetic participants in the Prevention of Renal and Vascular ENdstage Disease (PREVEND) study, a Dutch cohort derived from the general population. We defined three domains of vascular disease; coronary heart disease (myocardial infarction or infarct pattern on the ECG), renal insufficiency (creatinine clearance <60 ml min−1) and peripheral artery disease (ankle brachial index <0.9 or lower limb revascularisation). The prevalence of an elevated CRP (27.7 vs. 17.9%) and MA (17.5 vs. 10.4%) were increased in subjects with vascular disease as compared with subjects without CVD. The prevalence of an elevated CRP was equal in subjects with either coronary heart disease, renal insufficiency or peripheral artery disease (28.4 vs. 29.5 vs. 26.0%, NS), whereas MA was most prevalent in subjects with coronary heart disease (22.5 vs. 12.8 vs. 14.9%, P<0.05). Using multivariate analyses, CRP was independently associated with all three domains of vascular disease, whereas MA was independently associated with coronary heart disease only. In addition, we found synergistic contributions of an elevated CRP and older age to the risk of vascular disease in all three domains. Thus, CRP and MA are risk markers for vascular disease, each showing a different risk profiling for different vascular beds.


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