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. 2012 Sep;224(1):274-9.
doi: 10.1016/j.atherosclerosis.2012.07.017. Epub 2012 Jul 20.

Intraindividual variability of C-reactive protein: the Multi-Ethnic Study of Atherosclerosis

Emil M DeGoma  1 , Benjamin French, Richard L Dunbar, Matthew A Allison, Emile R Mohler 3rd, Matthew J Budoff
Affiliations

Intraindividual variability of C-reactive protein: the Multi-Ethnic Study of Atherosclerosis

Emil M DeGoma et al. Atherosclerosis. 2012 Sep.

Abstract

Background: The intraindividual variability of C-reactive protein (CRP) remains uncertain. Although guidelines suggest stability of serial CRP values comparable to that of cholesterol measures, several studies indicate greater fluctuations of CRP. We sought to compare the intraindividual variability of CRP with that of cholesterol measures using the multi-ethnic study of atherosclerosis (MESA).

Methods: CRP measurements were available in 760 MESA participants after exclusion of those with comorbidities or medications known to affect CRP or CRP≥10 mg/L. Serial values were available for 255 participants. The intraclass correlation coefficient (ICC) was quantified for CRP, total cholesterol (TC), and non-HDL-cholesterol (non-HDL-C) as the ratio of between-subject variance to the sum of between-subject and within-subject variance. Fluctuation between baseline and follow-up categories was calculated by cross-classifying participants according to baseline tertiles.

Results: The multivariable-adjusted ICC of CRP was 0.62 (95% CI, 0.55-0.68), significantly lower than that of TC (0.75; 95% CI, 0.70-0.81; p = 0.001 vs CRP) and non-HDL-C (0.76; 95% CI, 0.71-0.81; p = 0.001 vs CRP). 51% of participants in the highest baseline CRP tertile had discordant values on follow-up, while 54% and 27% were discordant in the middle and lowest baseline CRP tertiles. Among participants with baseline CRP levels exceeding 3 mg/L, a clinical threshold for higher risk, 69% had subsequent measurements falling within a lower risk category.

Conclusions: In the MESA cohort, intraindividual variation of CRP was significantly greater than that for cholesterol measures. Our results suggest that further evaluation of CRP variability is needed in large prospective studies using shorter intervals between measurements.

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Conflict of interest statement

Competing interests: The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Follow-up versus baseline C-reactive protein level and total cholesterol level; shaded region indicates 95% confidence band based on the estimated linear association between follow-up and baseline.
Figure 2
Figure 2
Change from baseline to follow-up C-reactive protein category and non-HDL cholesterol category; categories defined by tertiles of baseline levels.
Figure 3
Figure 3
Overview of studies examining the intraindividual variability of C-reactive protein and total cholesterol. Time intervals from baseline CRP measures were as follows: JUPITER, 3 months, 1, 2, 3, 4 years, trial termination; MESA, 1.4 years, 3.3 years; MONICA, 3 years; Nasermoaddeli, 1 year; SEASON, 3, 6, 9, 12 months; Wu, 2 years.
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