Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China.
Front Public Health. 2022 Oct 3;10:919506. doi: 10.3389/fpubh.2022.919506. eCollection 2022.
This study aimed to examine whether the combination of elevated-C-reactive protein (CRP) levels and hypertension increased the risk of stroke among middle-aged and elderly Chinese.
This analysis included 9,821 Chinese participants aged ≥45 years in the China Health and Retirement Longitudinal Study (CHARLS). Data based on three waves of CHARLS were used (2011, 2013, and 2015). Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with a 95% confidence interval (95%CI) of new-onset stroke risk according to elevated-CRP level and hypertension. Moreover, the area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the incremental predictive value.
A total of 184 stroke events occurred during follow-up. The median follow-up time was 4 years. Compared with those with normal CRP levels (CRP ≤ 3 mg /L) and blood pressure, the adjusted HRs and 95%CI were 1.86 (0.90-3.85) for individuals with elevated-CRP levels alone, 2.70 (1.71-4.28) for those with hypertension alone, and 4.80 (2.83-8.12) for those with comorbid elevated-CRP levels and hypertension. People with the coexistence of elevated-CRP levels and hypertension had the highest risk of new-onset stroke among all subgroup analyses. Finally, adding the combination of elevated-CRP levels and hypertension to conventional factors significantly improved the risk prediction for new-onset stroke.
Our findings indicate that the combined effect of elevated-CRP levels and hypertension increase the risk of new-onset stroke among the middle-aged and geriatric Chinese population.
本研究旨在探讨中国中老年人中，高 C 反应蛋白（CRP）水平和高血压联合是否会增加中风风险。
本分析纳入了中国健康与退休纵向研究（CHARLS）中 9821 名年龄≥45 岁的中国参与者。使用 CHARLS 的三波数据（2011 年、2013 年和 2015 年）。使用多变量 Cox 比例风险回归模型，根据 CRP 水平升高和高血压，估计新发生中风风险的危险比（HR）及其 95%置信区间（95%CI）。此外，还使用曲线下面积（AUC）、净重新分类指数（NRI）和综合判别改善（IDI）来评估增量预测价值。
随访期间共发生 184 例中风事件。中位随访时间为 4 年。与 CRP 水平正常（CRP≤3mg/L）且血压正常者相比，单独 CRP 水平升高者的调整 HR 及其 95%CI 为 1.86（0.90-3.85），单纯高血压者为 2.70（1.71-4.28），同时存在 CRP 水平升高和高血压者为 4.80（2.83-8.12）。在所有亚组分析中，同时存在 CRP 水平升高和高血压者发生新发中风的风险最高。最后，将 CRP 水平升高和高血压联合纳入常规因素可显著提高新发中风的风险预测。
本研究结果表明，高 CRP 水平和高血压的联合作用增加了中国中老年人群新发中风的风险。
