C-Reactive Protein and Risk of Cardiovascular and All-Cause Mortality in 268,803 East Asians

Study Questions:

What is the relation between C-reactive protein (CRP) and cardiovascular disease (CVD) and all-cause mortality in Koreans?

Methods:

Mortality outcomes for 268,803 Koreans enrolled in a health screening program with measurements of CRP at baseline and median follow-up of 4.49 years (1,155,930 person-years) were analyzed. A subset (48%) of subjects had a repeat CRP measurement during follow-up. The median (interquartile) baseline CRP values were higher in men than in women [0.6 mg/L (0.3-1.3) vs. 0.4 mg/L (0.1-1.1), p < 0.001].

Results:

Only 8.6% of men and 6.2% of women met the standard cut point for CRP >3 mg/L, which represents the top tertile in white populations. During a median follow-up of 4.49 years (1,155,930 person-years), 1,047 died; 187 died of CVD causes. In men but not women, baseline CRP quartiles were linearly associated with both CVD and all-cause mortality (p < 0.001), even after adjustment for known CVD risk factors. Regardless of baseline CRP concentration, any increase or decrease in CRP over time did not affect the hazard ratio for all-cause or CVD mortality. Models with CRP yielded a net reclassification improvement for CVD mortality of 24.9% (p = 0.04) for individuals with intermediate risk.

Conclusions:

CRP concentrations are substantially lower in Koreans than reported for white populations. Nonetheless, CRP levels are associated with CVD and all-cause mortality in Korean men. Standard cut points for CRP may under-represent Asians at risk for CVD.

Perspective:

East Asians, in particular, have different values for biomarkers of risk for diseases and drug metabolism. That the CRP was an effective biomarker for men, but not women is another example of the complexity of identifying risk markers and risk factors. Interestingly, the net improvement in reclassification for CVD mortality of intermediate-risk Koreans with the CRP is similar to whites even at the very low values.

Keywords: C-Reactive Protein, Follow-Up Studies, Biological Markers, European Continental Ancestry Group, Cardiovascular Diseases, Risk Factors


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