High-sensitivity C-reactive protein predicts mortality but not stroke: the Northern Manhattan Study.
OBJECTIVE
To determine whether high-sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA) predict stroke, vascular events, and mortality in a prospective cohort study.


BACKGROUND
Markers of inflammation have been associated with risk of myocardial infarction (MI). Their association with stroke is controversial.


METHODS
The Northern Manhattan Study includes a stroke-free community-based cohort study in participants aged > or =40 years (median follow-up 7.9 years). hsCRP and SAA were measured using nephelometry. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of markers with risk of ischemic stroke and other outcomes after adjusting for demographics and risk factors.


RESULTS
hsCRP measurements were available in 2,240 participants (mean age 68.9 +/- 10.1 years; 64.2% women; 18.8% white, 23.5% black, and 55.1% Hispanic). The median hsCRP was 2.5 mg/L. Compared with those with hsCRP <1 mg/L, those with hsCRP >3 mg/L were at increased risk of ischemic stroke in a model adjusted for demographics (HR = 1.60, 95% CI 1.06-2.41), but the effect was attenuated after adjusting for other risk factors (adjusted HR = 1.20, 95% CI 0.78-1.86). hsCRP >3 mg/L was associated with risk of MI (adjusted HR = 1.70, 95% CI 1.04-2.77) and death (adjusted HR = 1.55, 95% CI 1.23-1.96). SAA was not associated with stroke risk.


CONCLUSIONS
In this multiethnic cohort, high-sensitivity C-reactive protein (hsCRP) was not associated with ischemic stroke, but was modestly associated with myocardial infarction and mortality. The value of hsCRP and serum amyloid A may depend on population characteristics such as age and other risk factors.
Elkind
M S V
MS
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. mse13@columbia.edu
Luna
J M
JM
Moon
Y P
YP
Liu
K M
KM
Spitalnik
S L
SL
Paik
M C
MC
Sacco
R L
RL
D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality; D009391:Nephelometry and Turbidimetry; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D000685:Serum Amyloid A Protein / Q000378:metabolism*; D020521:Stroke / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality
D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein