C-reactive protein and risk of cardiovascular and all-cause mortality in 268 803 East Asians

Eur Heart J. 2014 Jul 14;35(27):1809-16. doi: 10.1093/eurheartj/ehu059. Epub 2014 Feb 25.


Aims: C-reactive protein concentrations are decreased in Asians compared with people of white European ethnicity. It is uncertain whether C-reactive protein is a robust biomarker of cardiovascular disease (CVD) in Asians. This study aimed to determine the association between C-reactive protein and CVD and all-cause mortality in a large population of Koreans.

Methods and results: Mortality outcomes for 268 803 Koreans enrolled in a health screening programme with measurements of C-reactive protein at baseline and median follow-up of 4.49 years (1 155 930 person-years) were analysed. A subset (48%) of subjects had a repeat C-reactive protein measurement during follow-up. The median (interquartile) baseline C-reactive protein values were higher in men than in women [0.6 (0.3-1.3) vs. 0.4 (0.1-1.1), P < 0.001]. Only 8.6% of men and 6.2% of women met the standard cut point for C-reactive protein >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), 1047 died; 187 died of CVD causes. In men but not women, baseline C-reactive protein 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 C-reactive protein concentration, any increase or decrease in C-reactive protein over time did not affect the HR for all-cause, or CVD mortality. Models with C-reactive protein yielded a net reclassification improvement for CVD mortality of 24.9% (P = 0.04) for individuals with intermediate risk.

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

Keywords: C-reactive protein; Cardiovascular and all-cause mortality; Cardiovascular risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / metabolism
  • Body Mass Index
  • C-Reactive Protein / metabolism*
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Epidemiologic Methods
  • Female
  • Humans
  • Male
  • Republic of Korea / epidemiology
  • Republic of Korea / ethnology
  • Sex Distribution


  • Biomarkers
  • C-Reactive Protein