Association of Initial and Longitudinal Changes in C-reactive Protein With the Risk of Cardiovascular Disease, Cancer, and Mortality

Navin Suthahar; Dongyu Wang; Joseph Pierre Aboumsallem; Canxia Shi; Sanne de Wit; Elizabeth E Liu; Emily S Lau; Stephan J L Bakker; Ron T Gansevoort; Bert van der Vegt; Manol Jovani; Bernard E Kreger; Greta Lee Splansky; Emelia J Benjamin; Ramachandran S Vasan; Martin G Larson; Daniel Levy; Jennifer E Ho; Rudolf A de Boer

doi:10.1016/j.mayocp.2022.10.013

Association of Initial and Longitudinal Changes in C-reactive Protein With the Risk of Cardiovascular Disease, Cancer, and Mortality

Mayo Clin Proc. 2023 Apr;98(4):549-558. doi: 10.1016/j.mayocp.2022.10.013.

Authors

Navin Suthahar¹, Dongyu Wang², Joseph Pierre Aboumsallem³, Canxia Shi³, Sanne de Wit³, Elizabeth E Liu⁴, Emily S Lau⁴, Stephan J L Bakker⁵, Ron T Gansevoort⁵, Bert van der Vegt⁶, Manol Jovani⁷, Bernard E Kreger⁸, Greta Lee Splansky⁹, Emelia J Benjamin¹⁰, Ramachandran S Vasan¹¹, Martin G Larson¹², Daniel Levy¹³, Jennifer E Ho¹⁴, Rudolf A de Boer¹⁵

Affiliations

¹ Department of Cardiology, University of Groningen, Groningen, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: n.suthahar@erasmusmc.nl.
² Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Biostatistics, Boston University, Boston, MA, USA.
³ Department of Cardiology, University of Groningen, Groningen, the Netherlands.
⁴ Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands.
⁶ Department of Pathology, University of Groningen, Groningen, the Netherlands.
⁷ Digestive Diseases and Nutrition, University of Kentucky Albert B. Chandler Hospital, Lexington, KY, USA.
⁸ Department of Medicine, School of Medicine, Boston University, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA.
⁹ The Framingham Heart Study, Framingham, MA, USA.
¹⁰ Department of Biostatistics, Boston University, Boston, MA, USA; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA; Department of Medicine, School of Medicine, Boston University, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA.
¹¹ Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA; Department of Medicine, School of Medicine, Boston University, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA.
¹² Department of Biostatistics, Boston University, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA.
¹³ The Framingham Heart Study, Framingham, MA, USA; Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
¹⁴ Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹⁵ Department of Cardiology, University of Groningen, Groningen, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: r.a.deboer@erasmusmmc.nl.

Abstract

Objective: To evaluate the value of serial C-reactive protein (CRP) measurements in predicting the risk of cardiovascular disease (CVD), cancer, and mortality.

Methods: The analysis was performed using data from two prospective, population-based observational cohorts: the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study and the Framingham Heart Study (FHS). A total of 9253 participants had CRP measurements available at two examinations (PREVEND: 1997-1998 and 2001-2002; FHS Offspring cohort: 1995-1998 and 1998-2001). All CRP measurements were natural log-transformed before analyses. Cardiovascular disease included fatal and nonfatal cardiovascular, cerebrovascular and peripheral vascular events, and heart failure. Cancer included all malignancies except nonmelanoma skin cancers.

Results: The mean age of the study population at baseline was 52.4±12.1 years and 51.2% (n=4733) were women. Advanced age, female sex, smoking, body mass index, and total cholesterol were associated with greater increases in CRP levels over time (P_all<.001 in the multivariable model). Baseline CRP, as well as increase in CRP over time (ΔCRP), were associated with incident CVD (hazard ratio [HR]: 1.29 per 1-SD increase; 95% confidence interval [CI]: 1.29 to 1.47, and HR per 1-SD increase: 1.19; 95% CI: 1.09 to 1.29 respectively). Similar findings were observed for incident cancer (baseline CRP, HR: 1.17; 95% CI: 1.09 to 1.26; ΔCRP, HR: 1.08; 95% CI: 1.01 to 1.15) and mortality (baseline CRP, HR: 1.29; 95% CI: 1.21 to 1.37; ΔCRP, HR: 1.10; 95% CI: 1.05 to 1.16).

Conclusion: Initial as well as subsequent increases in CRP levels predict future CVD, cancer, and mortality in the general population.

MeSH terms

Adult
C-Reactive Protein / analysis
Cardiovascular Diseases* / epidemiology
Female
Humans
Male
Middle Aged
Neoplasms*
Prospective Studies
Risk Factors

Substances

C-Reactive Protein

Abstract

MeSH terms

Substances

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