Coronary heart disease: elevated fibrinogen, CRP and leukocyte counts and decreased albumin increases the risk

Clinical bottom line (level 1a)

  1. Patients with long-term elevated fibrinogen, CRP or leukocyte counts are at increased risk of coronary heart disease.
  2. Patients with long-term decreased albumin levels are at increased risk of coronary heart disease.
Danesh et al: JAMA 1998; 279 : 1477-1482
Expires January 2004

The study

Systematic review of all long-term prospective studies of
  • Patients: healthy or previous coronary heart disease
  • Intervention: elevated fibrinogen, CRP, leukocyte count; decreased albumin
  • Outcome: coronary heart disease
Articles found in all languages using Medline, to 1998 (search terms: fibrinogen, C-reactive protein, CRP, albumin, leukocyte, leucocyte, white cell count, acute phase reactants and coroanry heart disease, myocardial infarction, atherosclerosis, vascular disease ) and searching relevant reference lists; hand-searching a number of cardiology, epidemiology and other relevant journals; corresponding with authors of certain reports

Selection criteria: see above and below
Appraisal criteria: size and type of cohort, duration of follow-up; adjustment for potential confounders
Articles excluded if: not given

The following studies were found:
  • fibrinogen: 18 studies involving 4018 CHD cases
  • CRP: 7 studies involving 1053 CHD cases
  • albumin: 8 studies involving 3770 CHD cases
  • leukocyte count: 7 studies involving 5337 CHD cases

  • Relative risks compared patients in results in the top third with patients with results in the bottom third.
Studies were not found to be significantly heterogeneous.

The evidence

prognostic factor for
coronary heart disease 		adjusted RR
(95% CI)
elevated fibrinogen 1.8
(1.6 to 2.0)
elevated CRP 1.7
(1.4 to 2.1)
decreased albumin 1.5
(1.3 to 1.7)
elevated leukocyte count 1.4
(1.3 to 1.5)

  • difference in long-term mean test results between upper third and lower third
    • fibrinogen: 10.3 micromol/L v. 7.4 micromol/L
    • CRP: 2.4 mg/ L v. 1.0 mg/L
    • albumin: 38 g/L v. 42 g/L
    • leukocyte count: 8.4 x 10^9/L v. 5.6 x 10^9/L

Comments

  1. Event rates were not given so NNF or NNF+ could not be calculated.

Citation

  1. Danesh J, Collins R, Appleby P, et al: association of fibrinogen, C-reactive protein, albumin or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998; 279 : 1477-1482
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Contributor: Chris Ball, January 2002
Reviewer:

Clinical Question.
Patient healthy or previous coronary heart disease
Intervention or Exposure elevated fibrinogen, CRP or leukocyte count; decreased albumin
Outcome coronary heart disease