Prevention & lipidsCohort study
C-reactive protein and cardiovascular risk among women with no standard modifiable risk factors: evaluating the ‘SMuRF-less but inflamed’
- Prospective cohort study
Authors' conclusion
Over a 30-year horizon, cardiovascular events commonly occur among 'SMuRF-less but inflamed' women who are otherwise missed by current screening algorithms
Study context
- Population
- Initially healthy American women with no standard modifiable risk factors (hypertension, dyslipidaemia, DM, smoking), Women's Health Study973 first major CV events
- Participants
- 12,530 women
- Exposure
- High-sensitivity C-reactive protein (hsCRP) quintiles and clinical thresholds in SMuRF-less women
- Outcome
- Incident CHD
- Follow-up
- 30 years
Main finding
Incident CHD by hsCRP quintile (age-adjusted)
Hazard ratio
1.21
95% CI 1.13–1.29
P < 0.0001
By group
Q1
1.0
HR
Q2
1.24
HR
Q3
1.41
HR
Q4
1.57
HR
Q5
2.23
HR
Per increasing hsCRP quintile
HR 1.21 (95% CI 1.13–1.29); P < 0.0001
Per increasing hsCRP quintile, as printed
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Ischaemic stroke and total CVD events, top vs bottom quintile — Q5 vs Q1 · ischaemic stroke | 1.69 (1.16–2.47) | ||
| Ischaemic stroke and total CVD events, top vs bottom quintile — Q5 vs Q1 · total CVD events | 1.74 (1.42–2.14) | ||
| CHD, adjusted additionally for BMI and eGFR — Q5 vs Q1 · covariate-adjusted | 1.86 (1.35–2.58) | P = 0.0002 | |
| CHD, adjusted additionally for BMI and eGFR — hsCRP > 3 mg/L vs hsCRP < 1 mg/L · covariate-adjusted | 1.52 (1.20–1.92) | P = 0.0006 | |
| 0.20.5125Hazard ratio (log scale) |
Baseline hsCRP, women with vs without CV event
- Median hsCRP 2.22 vs 1.50 mg/L
- P < 0.0001
hsCRP > 3 vs < 1 mg/L
- Higher risk of coronary heart disease (CHD)
- 77%
- Higher risk of ischaemic stroke
- 39%
- Higher risk of total CVD events
- 52%
Original publication
C-reactive protein and cardiovascular risk among women with no standard modifiable risk factors: evaluating the ‘SMuRF-less but inflamed’. Eur Heart J. Published 29 August 2025. doi:10.1093/eurheartj/ehaf658
Summarised from the published abstract; every number is checked against it