title: Ethnicity and sex modify the association of serum c-reactive protein with microalbuminuria.
abstract: OBJECTIVE
  To study the association between serum C-reactive protein (CRP) and urinary albumin excretion in the Multi-Ethnic Study of Atherosclerosis and to assess whether the association is modified by ethnicity, sex, or systolic blood pressure.
  
  
  METHODS
  This was a cross-sectional study of 6675 participants who were free from macroalbuminuria and clinical cardiovascular disease (mean age 62.1 years, 53% female; 39% White, 27% African American, 22% Hispanic, and 12% Chinese). Urinary albumin excretion was measured by spot urine albumin-to-creatinine ratio (ACR). Effect modifications were tested after adjusting for age, diabetes, body mass index, smoking, use of angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, other antihypertensive drugs, estrogens, statins, and high-density lipoprotein cholesterol and triglyceride levels.
  
  
  RESULTS
  The association between CRP and ACR was modified by ethnicity (P=.01) and sex (P<.001), but not by systolic blood pressure. After multivariate adjustment, the association remained in Chinese, African American, and Hispanic men and African American women (P<.02 for African American men, and P<.04 for the other subgroups).
  
  
  CONCLUSIONS
  The association between CRP and ACR was modified by ethnicity and sex; it was stronger in non-White men and African American women. These interactions have not been reported before, and future studies should consider them.
authors.affiliation: Department of Medicine, Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Palmas
authors.forename: Shuangge
authors.initials: S
authors.lastname: Ma
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Donna
authors.initials: D
authors.lastname: Arnett
authors.forename: Sharon
authors.initials: S
authors.lastname: Jackson
authors.forename: Jean
authors.initials: J
authors.lastname: Olson
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Saad
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000097:blood* / Q000208:ethnology* / Q000503:physiopathology; D050197:Atherosclerosis / Q000208:ethnology / Q000378:metabolism / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D002097:C-Reactive Protein
references.citation: Hypertension. 2005 Jul;46(1):38-43
references.pmid: 15956113
references.citation: Arterioscler Thromb Vasc Biol. 2002 Oct 1;22(10):1662-7
references.pmid: 12377746
references.citation: J Clin Epidemiol. 1992 Jun;45(6):683-92
references.pmid: 1607909
references.citation: Circulation. 2003 Jan 28;107(3):363-9
references.pmid: 12551853
references.citation: Am J Kidney Dis. 1995 Dec;26(6):904-9
references.pmid: 7503064
references.citation: Am J Epidemiol. 2002 Jun 15;155(12):1114-9
references.pmid: 12048225
references.citation: Am J Epidemiol. 2002 Nov 1;156(9):871-81
references.pmid: 12397006
references.citation: Intern Med. 2004 Oct;43(10):919-25
references.pmid: 15575240
references.citation: J Am Coll Cardiol. 2005 Aug 2;46(3):464-9
references.pmid: 16053959
references.citation: Am J Hypertens. 2006 May;19(5):467
references.pmid: 16647615
references.citation: Diabetologia. 1995 May;38(5):610-6
references.pmid: 7489846
references.citation: Circulation. 2005 Aug 16;112(7):969-75
references.pmid: 16087792
references.citation: N Engl J Med. 2002 Nov 14;347(20):1557-65
references.pmid: 12432042
references.citation: Circulation. 2004 Jul 27;110(4):380-5
references.pmid: 15262834
references.citation: Hypertension. 2004 Apr;43(4):791-6
references.pmid: 14967837
references.citation: J Hypertens. 1998 Sep;16(9):1325-33
references.pmid: 9746120
references.citation: Stroke. 1988 Jan;19(1):1-9
references.pmid: 3276035
references.citation: J Am Soc Nephrol. 2004 Dec;15(12):3184-91
references.pmid: 15579522
references.citation: Hypertension. 1995 Mar;25(3):305-13
references.pmid: 7875754
references.citation: Am J Hypertens. 1996 Aug;9(8):770-8
references.pmid: 8862223
references.citation: Diabetologia. 2003 Oct;46(10):1402-7
references.pmid: 12928771
references.citation: Kidney Int. 2000 Oct;58(4):1703-10
references.pmid: 11012904
references.citation: J Am Soc Nephrol. 2003 Nov;14(11):2902-7
references.pmid: 14569100
references.citation: J Intern Med. 2001 Dec;250(6):502-7
references.pmid: 11902818
references.citation: Am Heart J. 2006 Sep;152(3):593-8
references.pmid: 16923436
references.citation: Kidney Int. 2005 Jul;68(1):237-45
references.pmid: 15954913
references.citation: Am J Epidemiol. 1996 Feb 15;143(4):338-50
references.pmid: 8633618
references.citation: Arterioscler Thromb Vasc Biol. 2002 Apr 1;22(4):593-8
references.pmid: 11950696
references.citation: Ethn Dis. 2004 Winter;14(1):43-8
references.pmid: 15002922
references.citation: Stroke. 2005 Oct;36(10):2138-42
references.pmid: 16151032
references.citation: Diabetes Care. 1998 Apr;21(4):518-24
references.pmid: 9571335
references.citation: BMJ. 1996 Sep 28;313(7060):779-84
references.pmid: 8842069
references.citation: Am J Med. 2006 Jan;119(1):70.e1-8
references.pmid: 16431189
references.citation: J Am Soc Nephrol. 2002 Apr;13(4):1034-1039
references.pmid: 11912263
references.citation: J Hypertens Suppl. 2003 Mar;21(1):S7-12
references.pmid: 12769161
references.citation: J Am Soc Nephrol. 2003 May;14(5):1330-5
references.pmid: 12707402