The Impact of C-Reactive Protein on Risk of Stroke, Stroke Subtypes, and Ischemic Heart Disease in Middle-Aged Japanese: the Japan Public Health Center-Based Study

Abstract

Aim:To examine the impact of C-reactive protein on the risks of stroke and its subtypes, particularly among Asian populations in which median C-reactive protein levels are typically lower than in Western populations. Methods: A prospective, nested case-control study was conducted to examine the associations between high sensitivity-CRP (hs-CRP) and risks of cardiovascular disease within a cohort of 29,876 men and women aged 40-69 years, with no history of stroke, ischemic heart disease or cancer, who submitted blood samples between 1990 and 1993. Systematic cardiovascular surveillance was performed throughout 2007. One control for each stroke and two controls for each ischemic heart disease were matched for sex, age, date of blood drawing, time since last meal and study location. Results: We documented 1,132 incident strokes (638 ischemic and 494 hemorrhagic strokes) and 209 ischemic heart diseases (168 myocardial infarctions and 41 sudden cardiac deaths), and observed a linear association between hs-CRP levels and risks of ischemic stroke and ischemic heart disease, more specifically myocardial infarction. The multivariable odds ratios associated with 1-SD increment of logarithmically transformed hs-CRP were 1.13 (0.99-1.29), p=0.07 for ischemic stroke, 1.16 (0.96-1.41), p=0.13 for lacunar infarction, 1.41 (0.98-2.01), p=0.06 for embolic infarction, and 1.28 (1.03-1.59), p= 0.03 for myocardial infarction. The predictive value of hs-CRP for ischemic stroke was reduced primarily after adjustment for hypertensive status and body mass index. No association was found between hs-CRP levels and the risk of hemorrhagic or total stroke. Conclusions: High serum hs-CRP levels were associated with the risk of myocardial infarction and more weakly with the risk of ischemic stroke among middle-aged Japanese men and women.

Correlations Between the Level of High-Sensitivity C-Reactive Protein and Cardiovascular Risk Factors in Korean Adults with Cardiovascular Disease or Diabetes Mellitus: The CALLISTO Study

“…Acute reactant hsCRP, an important marker of inflammation, appears to stimulate endothelial dysfunction and promote inflammation in the vessel wall, thus contributing to the initiation and progression of atherogenesis 13,14) and an increased risk of cardiovascular events 15,16) . Several prospective epidemiologic and randomized controlled studies of statin therapy have shown that the hsCRP level is either an independent predictor of future cardiovascular risk 7,[17][18][19] or provides additive value, together with other traditional risk factors, for predicting cardiovascular events 20,21) .…”

Differences in traditional and non-traditional risk factors with special reference to nutritional factors in patients with coronary artery disease with or without diabetes mellitus

“…In a study among US adults aged 17 years and over, elevated CRP concentrations increased with increasing HbA1c levels, and suggested an association between glycemic control and systemic inflammation in people with established diabetes. [48] Increase in inflammatory markers has been associated with progression of CAD[49] and diabetes[50] in prospective, population-based studies. However, in the present study, although the TNF-α level was higher in diabetic patients than in non-diabetic patients, it did not show any association with insulin resistance.…”

“…Larger studies had shown a positive correlation of TNF-α with insulin resistance. [4950] TNF-α is also associated with the amount of adipose tissue. [46] There was no difference in BMI in both groups in this study, which may explain our finding.…”

Relationship Between Serum High‐Sensitivity C‐Reactive Protein and Myocardial Infarction in a General Japanese Population

“…We previously found that the CRP level was markedly lower in Japanese people than in Westerners (13). Then, a few studies using prospective cohort data reported serum CRP as a predictor of ischemic/coronary heart disease in Japanese people (14)(15)(16), while these studies were performed in a single region without a genderseparated analysis (14) or in a nested case-control design (15,16). In contrast to the studies, the present prospective cohort study, the Jichi Medical School (JMS) Cohort Study, consisted of general Japanese residents in multiregional communities (17).…”