Joint effect of elevated-c-reactive protein level and hypertension on new-onset stroke: A nationwide prospective cohort study of CHARLS

Abstract

Background and aimsThis 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.MethodsThis 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.ResultsA 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.ConclusionOur 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.

The non-linear link between non-high-density lipoprotein to high-density lipoprotein ratio and the risk of stroke in middle-aged and older adults in Chinese: a prospective cohort study from the China health and retirement longitudinal study

“…Comparing individuals with a non-HDL-c/HDL-c ratio<2.685 to those with a ratio≥2.685, it was observed that the latter group generally exhibited higher levels of WBC, PLT, FPG, Scr, TG, LDL-c, hs-CRP, HbA1c, UA, BMI, SBP, and DBP ( Supplementary Table S4 ). However, it is important to note that these indicators are closely associated with stroke ( 18 – 21 , 27 , 49 – 51 ). When the non-HDL-c/HDL-c ratio exceeds 2.685, the presence of these stroke risk factors diminishes the impact of the ratio on stroke risk.…”

“…Covariates were selected based on previous research and our clinical knowledge ( 17 , 23 , 27 ). The following factors were included as covariates: (i) categorical variables: diabetes mellitus (DM), sex, hypertension, chronic lung disease (CLD), smoking status, coronary heart disease (CHD), drinking status, chronic kidney disease(CKD), daily activity, antihypertensive drug use, antihyperglycemic drug use, antihyperlipidemic drug use, malignant tumors, mental disease,; (ii) continuous variables: age, white blood cell (WBC), hs-CRP, HGB, blood urea nitrogen (BUN), PLT, body mass index (BMI), diastolic blood pressure (DBP), TG, systolic blood pressure (SBP), UA, hemoglobin A1c (HbA1c), and serum creatinine (Scr).…”

Non-linear dose-response relationship between body mass index and stroke risk in middle-aged and elderly Chinese men: a nationwide Longitudinal Cohort Study from CHARLS

“…The CHARLS, an ongoing population-based, longitudinal cohort research that is now being conducted nationally to evaluate economic, social, and health status, provided the data for this study ( 18 , 19 ). The CHARLS sample was obtained from 450 communities in 150 districts and 28 provinces through multi-stage probability sampling, with 10,257 households participating in the baseline survey and 17,708 participants.…”

“…The CHARLS sample was obtained from 450 communities in 150 districts and 28 provinces through multi-stage probability sampling, with 10,257 households participating in the baseline survey and 17,708 participants. The sample was drawn from the Chinese population aged 45 or older at baseline (June 2011 to March 2012) ( 18 , 19 ). All participants were assessed by one-on-one interviews using a standardized questionnaire.…”

“…Participants who did not have a history of stroke episodes at the baseline survey but reported a stroke experience at the follow-up were considered to have had a stroke event. As mentioned earlier ( 18 , 19 ), information about stroke events was collected using standardized questions: (i) Were you told by your doctor that you had been diagnosed with a stroke? (ii) When were you first diagnosed/aware of the disease yourself?…”