Hayes Cellas A, Thorpe Roland J, Dhamoon Mandip, Heitman Elizabeth, Norris Keith C, Beech Bettina M, Bruce Marino, Walker Benjamin, Reneker Jennifer C
Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA.
Department of Biomolecular Sciences, University of Mississippi School of Pharmacy, University, MS.
Ethn Dis. 2025 Mar 17;35(1):1-7. doi: 10.18865/EthnDis-2023-78. eCollection 2025 Mar.
Strokes are a leading cause of death and disability among African Americans in the United States. Biological markers to predict stroke remain elusive; thus, our objective was to investigate whether inflammation, as measured by high-sensitivity C-reactive protein (hs-CRP), was associated with stroke incidence among African Americans enrolled in the Jackson Heart Study (JHS).
Baseline hs-CRP levels were categorized in quintiles: quintile 1 (0.0084 mg/L); quintile 2 (0.0085-0.0189 mg/L); quintile 3 (0.0190-0.036 mg/L); quintile 4 (0.037-0.0675 mg/L); quintile 5 (≥0.0676 mg/L). Nonfatal stroke incidence was ascertained from passive community surveillance through annual phone calls and adjudicated via hospital records. At baseline, stroke risk factors/covariates were compared across quintiles using a one-way analysis of variance and a chi-square test. The association between baseline hs-CRP levels and stroke incidence was determined using a Cox regression analysis to estimate hazard ratios (HRs) and 95% confidence intervals (CI).
In the unadjusted model, hs-CRP levels in quintile 2 (HR, 1.48; 95% CI, 0.96-2.29), quintile 3 (HR, 1.44; 95% CI, 0.93-2.24), and quintile 4 (HR, 1.09; 95% CI, 0.68-1.74) were not associated with stroke incidence when compared with quintile 1 (reference). However, individuals within quintile 5 (HR, 1.78; 95% CI, 1.17-2.72) exhibited a significantly increased risk for stroke compared with those in the reference quintile. This risk persisted after adjusting for stroke risk factors (demographics, anthropometrics, health condition covariates, health behavioral risk factors, and cardiovascular disease history) for quintile 5 (HR, 1.87; 95% CI, 1.17-2.98) compared with reference quintile 1.
An increased and independent risk of nonfatal stroke appears at the highest quintile of hs-CRP values (≥0.0676 mg/L) among JHS participants.
在美国非裔美国人中，中风是导致死亡和残疾的主要原因之一。预测中风的生物标志物仍然难以捉摸；因此，我们的目标是调查在参加杰克逊心脏研究（JHS）的非裔美国人中，通过高敏C反应蛋白（hs-CRP）测量的炎症是否与中风发病率相关。
将基线hs-CRP水平分为五个五分位数：五分位数1（0.0084毫克/升）；五分位数2（0.0085 - 0.0189毫克/升）；五分位数3（0.0190 - 0.036毫克/升）；五分位数4（0.037 - 0.0675毫克/升）；五分位数5（≥0.0676毫克/升）。通过每年电话进行的被动社区监测确定非致命性中风发病率，并通过医院记录进行判定。在基线时，使用单因素方差分析和卡方检验比较各五分位数之间的中风危险因素/协变量。使用Cox回归分析确定基线hs-CRP水平与中风发病率之间的关联，以估计风险比（HRs）和95%置信区间（CI）。
在未调整模型中，与五分位数1（参考值）相比，五分位数2（HR，1.48；95% CI，0.96 - 2.29）、五分位数3（HR，1.44；95% CI，0.93 - 2.24）和五分位数4（HR，1.09；95% CI，0.68 - 1.74）的hs-CRP水平与中风发病率无关。然而，五分位数5的个体（HR，1.78；95% CI，1.17 - 2.72）与参考五分位数相比，中风风险显著增加。在对五分位数5的中风危险因素（人口统计学、人体测量学、健康状况协变量、健康行为危险因素和心血管疾病史）进行调整后，与参考五分位数1相比，这种风险仍然存在（HR，1.87；95% CI，1.17 - 2.98）。
在JHS参与者中，hs-CRP值最高五分位数（≥0.0676毫克/升）出现非致命性中风的风险增加且具有独立性。
