Systemic inflammation is associated with incident stroke and heart disease in East Asians

China Kadoorie Biobank (CKB) collaborative group, Mohd A Karim, Christiana Kartsonaki, Derrick A Bennett, Iona Y Millwood, Michael R Hill, Daniel Avery, Zheng Bian, Huaidong Du, Yu Guo, Yijian Qian, Chan Qu, Iain Turnbull, Dan Schmidt-Valle, Chunmei Wang, Canqing Yu, Jun Lv, Junshi Chen, Robert Clarke, Liming LiZhengming Chen, Michael V Holmes, Robin G Walters

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    17 Citations (Scopus)
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    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 languageEnglish
    Article number5605
    Number of pages11
    JournalScientific Reports
    Issue number1
    Early online date27 Mar 2020
    Publication statusPublished - 1 Dec 2020

    Bibliographical note

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    A Publisher Correction to this article was published on 12 May 2020


    • Myocardial infarction
    • Predictive markers
    • Stroke

    ASJC Scopus subject areas

    • General


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