Distributions of C-Reactive Protein Measured by High-Sensitivity Assays in Apparently Healthy Men and Women from Different Populations in Europe (Technical Briefs‪)‬

C-reactive protein (CRP), the classic marker of acute-phase response, is an indicator of a variety of pathologic processes, including infections, tissue damage, and chronic inflammatory diseases (1,2). The majority of more than 15 well-conducted prospective studies in initially healthy individuals have shown a strong and independent association between concentrations of CRP within the reference interval (5 mg/L) and future major cardiovascular events (3), although in some of them, no such association could be established (4-7). The summary estimate of the relative risk in formal metaanalysis was 2.0 (95% confidence interval, 1.6-2.5) (3). Furthermore, CRP has been shown to add to risk prediction beyond and above established cardiovascular risk factors (8). On the basis of data from the Physicians' Health Study and the Nurses' Health Study, an algorithm for risk assessment of future coronary events that combines both CRP concentration and the ratio of total cholesterol to HDL-cholesterol has recently been proposed (9). Because atherosclerosis represents a low-grade inflammatory process in the vascular bed, high-sensitivity (hs) assays are needed when using circulating CRP concentrations for risk prediction in cardiovascular diseases. Such assays have been developed and are now commercially available (10,11). However, before screening of individuals at risk can be recommended, CRP distributions in apparently healthy adults in the general population must be known. Such information is scarce. Furthermore, in previous reports, women using oral contraceptives or receiving hormone replacement therapy (HRT), both of which have been shown to significantly increase CRP concentrations, had not been excluded (12-15). In this report, we describe the frequency distribution of CRP concentrations in 13 527 adult men and women from different representative populations in Western Europe. Furthermore, for one area [the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) project in Augsburg], data from four surveys at 5-year intervals were available, thus providing information on potential CRP changes in the same population over time.