Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea
Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
Eur Heart J. 2014 Jul 14;35(27):1809-16. doi: 10.1093/eurheartj/ehu059. Epub 2014 Feb 25.
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.
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.
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.
与白种欧洲人相比，亚洲人的 C 反应蛋白浓度较低。目前尚不确定 C 反应蛋白是否是亚洲人心血管疾病（CVD）的一个强有力的生物标志物。本研究旨在确定在一个大型韩国人群中，C 反应蛋白与 CVD 和全因死亡率之间的关联。
对参加健康筛查计划的 268803 名韩国人进行了死亡率分析，这些人在基线时测量了 C 反应蛋白，中位随访时间为 4.49 年（1155930 人年）。在随访期间，有一部分（48%）受试者重复测量了 C 反应蛋白。男性的基线 C 反应蛋白中位数（四分位间距）高于女性[0.6（0.3-1.3）比 0.4（0.1-1.1），P<0.001]。只有 8.6%的男性和 6.2%的女性符合 C 反应蛋白>3mg/L 的标准切点，这代表白人人群中的最高三分位。在中位随访 4.49 年（1155930 人年）期间，有 1047 人死亡，其中 187 人死于 CVD 原因。在男性中，但不是在女性中，基线 C 反应蛋白四分位数与 CVD 和全因死亡率均呈线性相关（P<0.001），即使在校正了已知的 CVD 危险因素后也是如此。无论基线 C 反应蛋白浓度如何，随着时间的推移，C 反应蛋白的任何增加或减少都不会影响全因或 CVD 死亡率的 HR。对于具有中间风险的个体，包含 C 反应蛋白的模型对 CVD 死亡率的净重新分类改善为 24.9%（P=0.04）。
与白种人群报告的水平相比，韩国人的 C 反应蛋白浓度明显较低。尽管如此，C 反应蛋白水平与韩国男性的 CVD 和全因死亡率相关。C 反应蛋白的标准切点可能会低估亚洲人心血管疾病的风险。
