Published online before print June 17, 2004, doi: 10.1161/01.ATV.0000135845.95890.4e
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© 2004 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
C-Reactive Protein as a Screening Test for Cardiovascular Risk in a Multiethnic Population
From the Department of Medicine (S.S.A., E.L., K.T., S.Y.), McMaster University, and Population Health Research Institute (S.S.A., F.R., Q.Y., E.L., K.T., S.Y.), Hamilton Health Sciences and McMaster University, Hamilton, Canada; Six Nations Health Services (B.D., R.J.), Ohsweken, Canada; University of Toronto (V.V.), Toronto, Canada; and the Department of Pathology and Molecular Medicine (M.M.), McMaster University, Hamilton, Canada; for the SHARE and SHARE-AP investigators.
Correspondence to Dr Sonia Anand, McMaster Clinic Room 522, Hamilton General Hospital, Hamilton Health Sciences, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2. E-mail anands{at}mcmaster.ca
Background— Small increases in the inflammatory marker C-reactive protein (CRP) are predictive of vascular events among asymptomatic individuals. There are few data supporting the use of CRP as a risk marker among nonwhite individuals.
Methods and Results— 1250 adults of South Asian, Chinese, European, and Aboriginal ancestry were randomly sampled from 4 communities in Canada. Participants provided fasting blood samples for CRP, glucose, lipids, and coagulation factors, and they had undergone a carotid B-mode ultrasound. Cardiovascular disease was determined by history and electrocardiogram. The age- and sex-adjusted mean CRP was 3.74 mg/L (standard error, 0.14) among Aboriginals, 2.59 mg/L (0.12) among South Asians, and 1.18 mg/L (0.13) among Chinese compared with 2.06 mg/L (0.12) among Europeans (overall P<0.0001). Differences in the CRP concentration between ethnic groups were substantially diminished, but not abolished, after adjustment for metabolic factors. CRP was independently associated with CVD after adjusting for the Framingham risk factors, atherosclerosis, anthropometric measurements, and ethnicity (OR=1.03 for a 0.1-increase in CRP; P=0.02).
Conclusions— CRP varies substantially between people of different ethnic origin and is influenced by their differences in metabolic factors. Prospective validation of CRP as a risk predictor for cardiovascular disease among nonwhite ethnic groups is required.
CRP varies substantially between people of different ethnic origin. Compared with Europeans, Aboriginals, South Asians, and Chinese have significantly different CRP distributions, which are influenced by metabolic factors including abdominal adiposity, body weight, and HbA1c. CRP is independently associated with CVD across all populations.
Key Words: C-reactive protein • ethnicity • risk • cardiovascular disease • metabolic syndrome
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