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For a novel
marker of cardiovascular risk to be useful clinically, not only must a consistent set of
prospective epidemiologic data exist, but the marker of interest must also add to the
predictive value associated with lipid screening. In this graph of the interaction between
elevated levels of CRP and elevated levels of total cholesterol, the height of each bar
represents the adjusted relative risk of a future vascular event in four study groups in
the Physicians' Health Study. The group with the highest risk are those who have both an
elevated CRP level and an elevated level of total cholesterol. The risk in this group is
greater than the product of the risks associated with either isolated hyperlipidemia or an
isolated elevation of CRP. Reference:
Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of
total and HDL cholesterol in determining risk of first myocardial infarction. Circulation
1998;97:2007-2011.
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