Comparison of relative and attributable risk of myocardial infarction and stroke according to C-reactive protein and low-density lipoprotein cholesterol levels

Eur J Epidemiol. 2007;22(7):429-38. doi: 10.1007/s10654-007-9141-2. Epub 2007 Jun 8.


C-reactive protein (CRP) was proposed as a stronger predictor of cardiovascular events than low-density lipoprotein cholesterol (LDL-C); however, these associations may differ between myocardial infarction (MI) and stroke. We compared statistically the associations of CRP and LDL-C levels with risk of MI versus stroke and examined to what extent consideration of CRP or LDL-C increases the population attributable fractions (PAFs) of MI and stroke beyond traditional risk factors among 27,548 subjects from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study in a case-cohort design. Among subjects without prior MI or stroke, 156 developed MI and 132 stroke during 6.0 years of follow-up. In adjusted competing risk analyses CRP was positively related to MI and stroke (P difference between endpoints = 0.55), whereas LDL-C was related to MI but not stroke (P difference between endpoints = 0.003). The PAF for smoking, diabetes, and hypertension combined was 0.76 for MI, and 0.58 for stroke. With additional consideration of CRP the PAFs were 0.80 and 0.68, while with addition of LDL-C the PAFs were 0.88 and 0.55. We conclude that CRP is equally strongly related to risk of MI and stroke, whereas LDL-C is related to risk of MI but not stroke. Consideration of LDL-C beyond smoking, diabetes and hypertension may increase the PAF of MI slightly more than CRP. In contrast, consideration of CRP but not of LDL-C may increase the PAF of stroke beyond these factors.

MeSH terms

  • Adult
  • Aged
  • Anticholesteremic Agents / therapeutic use
  • Aspirin / therapeutic use
  • Biomarkers / blood
  • C-Reactive Protein / analysis*
  • Cholesterol, LDL / blood*
  • Cohort Studies
  • Comorbidity
  • Diabetes Complications / physiopathology
  • Female
  • Germany / epidemiology
  • Humans
  • Hypertension / complications
  • Male
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / epidemiology
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Smoking / adverse effects
  • Stroke / blood
  • Stroke / diagnosis*
  • Stroke / epidemiology


  • Anticholesteremic Agents
  • Biomarkers
  • Cholesterol, LDL
  • C-Reactive Protein
  • Aspirin