ArticleEuropean heart journal2025
Low-density lipoprotein cholesterol, C-reactive protein, and lipoprotein(a) universal one-time screening in primary prevention: the EPIC-Norfolk study.
Article in European heart journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Machine Learning Models in Major Cardiovascular Adverse Events Prediction Based on Coronary Computed Tomography Angiography: Systematic Review.Journal of medical Internet research · 2025Pooled it
- Expert consensus on Lipoprotein(a) in the Gulf countries: Navigating cardiovascular risk and therapeutic advances.Atherosclerosis plus · 2026Article
- Two-Point Change Patterns of LDL-Cholesterol and hs-CRP and Risk of Major Adverse Cardiovascular Events in Middle-Aged and Older Chinese Adults: A Prospective Cohort Study.Health science reports · 2026Article
- Major cardiovascular events in first-degree relatives of individuals with elevated plasma lipoprotein(a): a registry-based cohort study.European heart journal · 2026Article
- Cardiovascular disease in women: traditional and sex-specific risk factors.European heart journal · 2026Review
- Review
- Estimating residual inflammatory risk: Further insights into repeat hsCRP Testing from the UK BioBank.American journal of preventive cardiology · 2026Article
- Combining Genomics With Lipid and Inflammatory Biomarkers to Predict Coronary Artery Disease Risk: UK Biobank Study.Journal of the American College of Cardiology · 2026Article
- Predictive value of combined TyG-BMI and hsCRP for clinical outcomes in patients with chronic coronary syndrome undergoing PCI: a retrospective cohort study.BMC cardiovascular disorders · 2026Article
- Biomarkers for Screening and Diagnosis of Heart Failure in Cardiovascular-Kidney-Metabolic Syndrome: A Narrative Review.International journal of molecular sciences · 2026Review
- Triglyceride-Rich Lipoproteins and Inflammation: Independent and Synergistic Roles in Cardiovascular Disease.Current atherosclerosis reports · 2026Review
- Clinical Significance of the C-Reactive Protein-Triglyceride-Glucose Index in Cardiovascular Disease, Stroke, Cardiovascular-Kidney-Metabolic Syndrome, Cancer, Diabetes, and Osteoporosis: A Narrative Review.International journal of general medicine · 2026Review
- Anti-inflammatory pharmacotherapy in patients with cardiovascular disease.European heart journal. Cardiovascular pharmacotherapy · 2025Review
- C-reactive protein and cardiovascular risk in the general population.European heart journal · 2025Article
- Brazilian Guideline on Dyslipidemias and Prevention of Atherosclerosis - 2025.Arquivos brasileiros de cardiologia · 2025Article
- Evolving strategies in cardiovascular disease prevention: 2025 American society for preventive cardiology highlights.American journal of preventive cardiology · 2025Review
- Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9): The Multifaceted Biology, Diseases, and Pharmaceutical Interventions.MedComm · 2025Review
- Key inflammatory players for infarcted mass and cardiac remodeling after acute myocardial infarction.Frontiers in cardiovascular medicine · 2025Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsRecent data from a large American cohort of women strongly support universal one-time screening for LDL cholesterol, high-sensitivity C-reactive protein (hsCRP), and lipoprotein(a) [Lp(a)] in primary prevention. This study addresses the validity and generalizability of this novel primary prevention strategy in a large prospective European cohort of initially healthy men and women.
methodsPlasma levels of LDL cholesterol, hsCRP, and Lp(a) were measured at study entry in 17 087 participants from the EPIC-Norfolk study who were subsequently followed over a period of 20 years for major adverse cardiovascular events (MACEs). Competing risk- and multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident MACE across quintiles of each biomarker and sought evidence of independent as well as additive effects over time were calculated.
resultsDuring the 20-year follow-up, a total of 3249 MACEs occurred. Increasing quintiles of baseline LDL cholesterol, hsCRP, and Lp(a) all predicted 20-year risks; the multivariable-adjusted HRs in a comparison of the top to bottom quintile were 1.78 (95% CI: 1.57-2.00) for LDL cholesterol, 1.55 (95% CI: 1.37-1.74) for hsCRP, and 1.19 (95% CI: 1.07-1.33) for Lp(a). Compared with individuals with no biomarker elevations, the multivariable-adjusted HRs for incident MACE were 1.33, 1.68, and 2.41 for those with one, two, or three biomarkers in the top quintile, respectively (all P < .001). Each biomarker demonstrated independent contributions to overall risk and findings were consistent in analyses stratified by sex.
conclusionsA single combined measure of LDL cholesterol, hsCRP, and Lp(a) among initially healthy European men and women was predictive of incident MACE during a 20-year period. These data replicate findings from a recent American cohort and strongly support universal screening for all three biomarkers in primary prevention.
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