Abstract
Systemic inflammation, reflected by increased plasma concentrations of C-reactive protein (CRP) and fibrinogen, is associated with increased risk of coronary heart disease, but its relevance for stroke types remains unclear. Moreover, evidence is limited in non-European populations. We investigated associations of CRP and fibrinogen with risks of incident major coronary events (MCE), ischemic stroke (IS) and intracerebral hemorrhage (ICH) in a cohort of Chinese adults. A nested case-control study within the prospective China Kadoorie Biobank included 1,508 incident MCE cases, 5,418 IS cases, 4,476 ICH cases, and 5,285 common controls, aged 30-79 years. High-sensitivity CRP and low-density lipoprotein cholesterol (LDL-C) were measured in baseline plasma samples from all participants, and fibrinogen in a subset (n = 9,380). Logistic regression yielded adjusted odds ratios (ORs) per SD higher usual levels of log-transformed CRP and fibrinogen. The overall mean (SD) baseline LDL-C was 91.6 mg/dL (24.0) and geometric mean (95% CI) CRP and fibrinogen were 0.90 mg/L (0.87-0.93) and 3.01 g/L (2.98-3.03), respectively. There were approximately log-linear positive associations of CRP with each outcome, which persisted after adjustment for LDL-C and other risk factors, with adjusted ORs (95% CI) per SD higher CRP of 1.67 (1.44-1.94) for MCE and 1.22 (1.10-1.36) for both IS and ICH. No associations of fibrinogen with MCE, IS, or ICH were identified. Adding CRP to prediction models based on established risk factors improved model fit for each of MCE, IS, and ICH, with small improvements in C-statistic and correct reclassification of controls to lower risk groups. Among Chinese adults, who have low mean LDL-C, CRP, but not fibrinogen, was independently associated with increased risks of MCE and stroke.
Original language | English |
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Article number | 5605 |
Number of pages | 11 |
Journal | Scientific Reports |
Volume | 10 |
Issue number | 1 |
Early online date | 27 Mar 2020 |
DOIs | |
Publication status | Published - 1 Dec 2020 |
Bibliographical note
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.A Publisher Correction to this article was published on 12 May 2020
Funding
The chief acknowledgement is to the collaborators and participants of China Kadoorie Biobank, to the project staff at Beijing, Oxford, and the 10 regional CKB centers, and to the China National Centre for Disease Control and Prevention (CDC) and its regional offices for assisting with the fieldwork. The baseline survey was supported by the Kadoorie Charitable Foundation, Hong Kong. Long-term follow-up and the second resurvey were supported by grants 088158/Z/09/Z and 104085/Z/14/Z from the UK Wellcome Trust, grant 2011BAI09B01 (2012\u20132014) from the Chinese Ministry of Science and Technology, and grant 81390541 from the Chinese National Natural Science Foundation. The British Heart Foundation, UK Medical Research Council, and Cancer Research UK provided core funding to the Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford. Dr Karim is supported by the Nuffield Department of Population Health (NDPH) Studentship for his DPhil. Dr Holmes is supported by a British Heart Foundation Intermediate Clinical Research Fellowship (FS/18/23/33512) and the National Institute for Health Research Oxford Biomedical Research Centre.
Funders | Funder number |
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Medical Research Council | |
Kadoorie Charitable Foundation | |
University of Oxford | |
Cancer Research UK | |
British Heart Foundation | |
Oxford NIHR Biomedical Research Centre | |
National Natural Science Foundation of China | |
Wellcome Trust Centre for Mitochondrial Research | 088158/Z/09/Z, 104085/Z/14/Z |
University of Oxford | FS/18/23/33512 |
Wellcome Trust | 088158 |
National Natural Science Foundation of China-Yunnan Joint Fund | 81390541 |
Chinese Ministry of Science and Technology | 2011BAI09B01 |
Keywords
- Myocardial infarction
- Predictive markers
- Stroke
ASJC Scopus subject areas
- General