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Clinical Chemistry 45: 2136-2141, 1999;
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(Clinical Chemistry. 1999;45:2136-2141.)
© 1999 American Association for Clinical Chemistry, Inc.


Articles

Clinical Efficacy of an Automated High-Sensitivity C-Reactive Protein Assay

Nader Rifai1,a, Russell P. Tracy2 and Paul M. Ridker3

1 Department of Laboratory Medicine, Children’s Hospital and Department of Pathology, Harvard Medical School, Boston, MA 02115.

2 Laboratory for Clinical Biochemistry Research, University of Vermont, Burlington, VT 05446.

3 Divisions of Preventive Medicine and Cardiovascular Disease and Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115.
a Address correspondence to this author at: Children’s Hospital, Department of Laboratory Medicine, 300 Longwood Ave., Boston, MA 02115. Fax 617-355-6081; e-mail rifai{at}a1.tch.harvard.edu

Background: Prospective studies have shown that C-reactive protein (CRP) can be used to predict risk of future cardiovascular events. High-sensitivity methods for CRP (hs-CRP) measurement are needed for this purpose.

Methods: We compared the clinical efficacy of an automated and commercially available latex-enhanced assay (Latex) for hs-CRP (Dade Behring) to a validated in-house ELISA, previously shown to predict future peripheral arterial disease (PAD) in asymptomatic populations. Using a prospective, nested, case-control design, we measured baseline hs-CRP concentrations in 144 apparently healthy men who subsequently developed symptomatic PAD and 144 age- and smoking habit-matched controls who remained free of vascular disease over the follow-up period of 60 months.

Results: The two hs-CRP assays correlated highly (r = 0.95; P <0.001), and all but two participants were classified into concordant quartiles or varied by only one quartile. The median hs-CRP of the case group was significantly higher than that of controls when measured by either the ELISA (1.34 vs 0.99 mg/L; P = 0.034) or the Latex method (1.80 vs 1.20 mg/L; P = 0.042). Furthermore, for both ELISA and the Latex method, the calculated relative risks of developing PAD increased significantly with each increasing quartile of hs-CRP. The calculated interquartile increase in relative risk of PAD was 31% (95% confidence interval, 5.2–62.2%; P = 0.01) for ELISA and 34% (95% confidence interval, 8.2–66.1%; P = 0.007) for the Latex method.

Conclusions: Our findings indicate that the Latex method is equally as efficacious as the validated ELISA in classifying patients into cutoff points established by prospective studies for risk stratification for coronary and cerebrovascular disease.




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CirculationHome page
S. Verma, C.-H. Wang, S.-H. Li, A. S. Dumont, P. W.M. Fedak, M. V. Badiwala, B. Dhillon, R. D. Weisel, R.-K. Li, D. A.G. Mickle, et al.
A Self-Fulfilling Prophecy: C-Reactive Protein Attenuates Nitric Oxide Production and Inhibits Angiogenesis
Circulation, August 20, 2002; 106(8): 913 - 919.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
R. Hayaishi-Okano, Y. Yamasaki, N. Katakami, K. Ohtoshi, S.-I. Gorogawa, A. Kuroda, M. Matsuhisa, K. Kosugi, N. Nishikawa, Y. Kajimoto, et al.
Elevated C-Reactive Protein Associates With Early-Stage Carotid Atherosclerosis in Young Subjects With Type 1 Diabetes
Diabetes Care, August 1, 2002; 25(8): 1432 - 1438.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
M. Ishibashi, Y. Takemura, H. Ishida, K. Watanabe, and T. Kawai
C-Reactive Protein Kinetics in Newborns: Application of a High-Sensitivity Analytic Method in Its Determination
Clin. Chem., July 1, 2002; 48(7): 1103 - 1106.
[Full Text] [PDF]


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CirculationHome page
C. M. Albert, J. Ma, N. Rifai, M. J. Stampfer, and P. M. Ridker
Prospective Study of C-Reactive Protein, Homocysteine, and Plasma Lipid Levels as Predictors of Sudden Cardiac Death
Circulation, June 4, 2002; 105(22): 2595 - 2599.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
D. C. Chan, G. F. Watts, P. H. R. Barrett, L. J. Beilin, and T. A. Mori
Effect of Atorvastatin and Fish Oil on Plasma High-Sensitivity C-Reactive Protein Concentrations in Individuals with Visceral Obesity
Clin. Chem., June 1, 2002; 48(6): 877 - 883.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
I. M. van der Meer, M. P.M. de Maat, M. L. Bots, M. M.B. Breteler, J. Meijer, A. J. Kiliaan, A. Hofman, and J. C.M. Witteman
Inflammatory Mediators and Cell Adhesion Molecules as Indicators of Severity of Atherosclerosis: The Rotterdam Study
Arterioscler Thromb Vasc Biol, May 1, 2002; 22(5): 838 - 842.
[Abstract] [Full Text] [PDF]


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ANN INTERN MEDHome page
N. Rifai, J. E. Buring, I-M. Lee, J. E. Manson, and P. M Ridker
Is C-Reactive Protein Specific for Vascular Disease in Women?
Ann Intern Med, April 2, 2002; 136(7): 529 - 533.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. Libby, P. M. Ridker, and A. Maseri
Inflammation and Atherosclerosis
Circulation, March 5, 2002; 105(9): 1135 - 1143.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
P. Tarkkinen, T. Palenius, and T. Lovgren
Ultrarapid, Ultrasensitive One-Step Kinetic Immunoassay for C-Reactive Protein (CRP) in Whole Blood Samples: Measurement of the Entire CRP Concentration Range with a Single Sample Dilution
Clin. Chem., February 1, 2002; 48(2): 269 - 277.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
G. J. Blake, N. Dada, J. C. Fox, J. E. Manson, and P. M. Ridker
A prospective evaluation of lipoprotein-associated phospholipase A2 levels and the risk of future cardiovascular events in women
J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1302 - 1306.
[Abstract] [Full Text] [PDF]


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JAMAHome page
A. D. Pradhan, J. E. Manson, N. Rifai, J. E. Buring, and P. M. Ridker
C-Reactive Protein, Interleukin 6, and Risk of Developing Type 2 Diabetes Mellitus
JAMA, July 18, 2001; 286(3): 327 - 334.
[Abstract] [Full Text] [PDF]


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NEJMHome page
P. M. Ridker, N. Rifai, M. Clearfield, J. R. Downs, S. E. Weis, J. S. Miles, A. M. Gotto Jr., and the Air Force/Texas Coronary Atherosclerosis Preve
Measurement of C-Reactive Protein for the Targeting of Statin Therapy in the Primary Prevention of Acute Coronary Events
N. Engl. J. Med., June 28, 2001; 344(26): 1959 - 1965.
[Abstract] [Full Text] [PDF]


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JAMAHome page
P. M. Ridker, M. J. Stampfer, and N. Rifai
Novel Risk Factors for Systemic Atherosclerosis: A Comparison of C-Reactive Protein, Fibrinogen, Homocysteine, Lipoprotein(a), and Standard Cholesterol Screening as Predictors of Peripheral Arterial Disease
JAMA, May 16, 2001; 285(19): 2481 - 2485.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. M. Ridker
High-Sensitivity C-Reactive Protein : Potential Adjunct for Global Risk Assessment in the Primary Prevention of Cardiovascular Disease
Circulation, April 3, 2001; 103(13): 1813 - 1818.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. M. Ridker, N. Rifai, and S. P. Lowenthal
Rapid Reduction in C-Reactive Protein With Cerivastatin Among 785 Patients With Primary Hypercholesterolemia
Circulation, March 6, 2001; 103(9): 1191 - 1193.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
N. Rifai and P. M. Ridker
High-Sensitivity C-Reactive Protein: A Novel and Promising Marker of Coronary Heart Disease
Clin. Chem., March 1, 2001; 47(3): 403 - 411.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
W. L. Roberts, L. Moulton, T. C. Law, G. Farrow, M. Cooper-Anderson, J. Savory, and N. Rifai
Evaluation of Nine Automated High-Sensitivity C-Reactive Protein Methods: Implications for Clinical and Epidemiological Applications. Part 2
Clin. Chem., March 1, 2001; 47(3): 418 - 425.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
H. K. Meier-Ewert, P. M. Ridker, N. Rifai, N. Price, D. F. Dinges, and J. M. Mullington
Absence of Diurnal Variation of C-Reactive Protein Concentrations in Healthy Human Subjects
Clin. Chem., March 1, 2001; 47(3): 426 - 430.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
I. S. Ockene, C. E. Matthews, N. Rifai, P. M. Ridker, G. Reed, and E. Stanek
Variability and Classification Accuracy of Serial High-Sensitivity C-Reactive Protein Measurements in Healthy Adults
Clin. Chem., March 1, 2001; 47(3): 444 - 450.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
W. Koenig
C-Reactive Protein and Cardiovascular Risk: Has the Time Come for Screening the General Population?
Clin. Chem., January 1, 2001; 47(1): 9 - 10.
[Full Text] [PDF]


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Clin. Chem.Home page
N. Rifai and P. M. Ridker
Proposed Cardiovascular Risk Assessment Algorithm Using High-Sensitivity C-Reactive Protein and Lipid Screening
Clin. Chem., January 1, 2001; 47(1): 28 - 30.
[Full Text] [PDF]


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CirculationHome page
S. G. Priori, C. Napolitano, N. Tiso, M. Memmi, G. Vignati, R. Bloise, V. Sorrentino, and G. A. Danieli
Mutations in the Cardiac Ryanodine Receptor Gene (hRyR2) Underlie Catecholaminergic Polymorphic Ventricular Tachycardia
Circulation, December 6, 2000; (2000) 11.
[Abstract] [Full Text]


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ANN INTERN MEDHome page
G. Sesmilo, B. M.K. Biller, J. Llevadot, D. Hayden, G. Hanson, N. Rifai, and A. Klibanski
Effects of Growth Hormone Administration on Inflammatory and Other Cardiovascular Risk Markers in Men with Growth Hormone Deficiency: A Randomized, Controlled Clinical Trial
Ann Intern Med, July 18, 2000; 133(2): 111 - 122.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
R. F. Redberg, N. Rifai, L. Gee, and P. M. Ridker
Lack of association of C-reactive protein and coronary calcium by electron beam computed tomography in postmenopausal women: implications for coronary artery disease screening
J. Am. Coll. Cardiol., July 1, 2000; 36(1): 39 - 43.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
W. L. Hutchinson, W. Koenig, M. Frohlich, M. Sund, G. D.O. Lowe, and M. B. Pepys
Immunoradiometric Assay of Circulating C-Reactive Protein: Age-related Values in the Adult General Population
Clin. Chem., July 1, 2000; 46(7): 934 - 938.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
W. L. Roberts, R. Sedrick, L. Moulton, A. Spencer, and N. Rifai
Evaluation of Four Automated High-Sensitivity C-Reactive Protein Methods: Implications for Clinical and Epidemiological Applications
Clin. Chem., April 1, 2000; 46(4): 461 - 468.
[Abstract] [Full Text] [PDF]


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NEJMHome page
P. M. Ridker, C. H. Hennekens, J. E. Buring, and N. Rifai
C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women
N. Engl. J. Med., March 23, 2000; 342(12): 836 - 843.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. K. Chung, D. O. Martin, D. Sprecher, O. Wazni, A. Kanderian, C. A. Carnes, J. A. Bauer, P. J. Tchou, M. J. Niebauer, A. Natale, et al.
C-Reactive Protein Elevation in Patients With Atrial Arrhythmias: Inflammatory Mechanisms and Persistence of Atrial Fibrillation
Circulation, December 11, 2001; 104(24): 2886 - 2891.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Verma, S.-H. Li, M. V. Badiwala, R. D. Weisel, P. W.M. Fedak, R.-K. Li, B. Dhillon, and D. A.G. Mickle
Endothelin Antagonism and Interleukin-6 Inhibition Attenuate the Proatherogenic Effects of C-Reactive Protein
Circulation, April 23, 2002; 105(16): 1890 - 1896.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. P. Burke, R. P. Tracy, F. Kolodgie, G. T. Malcom, A. Zieske, R. Kutys, J. Pestaner, J. Smialek, and R. Virmani
Elevated C-Reactive Protein Values and Atherosclerosis in Sudden Coronary Death: Association With Different Pathologies
Circulation, April 30, 2002; 105(17): 2019 - 2023.
[Abstract] [Full Text] [PDF]




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