Results:

In the 52 studies, mean age was 61 years, and 56% were men. The CRP was available in 67% of participants, among whom 12% had a first CVE (2/3rd coronary 1/3rd stroke) with a median of 6.7 years to first outcome. The addition of information on high-density lipoprotein cholesterol (HDL-C) to a prognostic model for CVD that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level, increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (p < 0.001), and yielded a net reclassification improvement of 1.52% and 0.83%, respectively, for the predicted 10-year risk categories of “low” (<10%), “intermediate” (10% to <20%), and “high” (≥20%) (p < 0.02 for both comparisons). It was estimated that among 100,000 adults 40 years of age or older, 15,025 persons would initially be classified as being at intermediate risk for a CVE if conventional risk factors alone were used to calculate risk. Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines (i.e., for persons with a predicted risk of ≥20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional CVEs over the course of 10 years.