title: C-reactive protein and risk of cardiovascular and all-cause mortality in 268 803 East Asians.
abstract: OBJECTIVE
  C-reactive protein concentrations are decreased in Asians compared with people of white European ethnicity. It is uncertain whether C-reactive protein is a robust biomarker of cardiovascular disease (CVD) in Asians. This study aimed to determine the association between C-reactive protein and CVD and all-cause mortality in a large population of Koreans.
  
  
  RESULTS
  Mortality outcomes for 268 803 Koreans enrolled in a health screening programme with measurements of C-reactive protein at baseline and median follow-up of 4.49 years (1 155 930 person-years) were analysed. A subset (48%) of subjects had a repeat C-reactive protein measurement during follow-up. The median (interquartile) baseline C-reactive protein values were higher in men than in women [0.6 (0.3-1.3) vs. 0.4 (0.1-1.1), P < 0.001]. Only 8.6% of men and 6.2% of women met the standard cut point for C-reactive protein >3 mg/L, which represents the top tertile in white populations. During a median follow-up of 4.49 years (1 155 930 person-years), 1047 died; 187 died of CVD causes. In men but not women, baseline C-reactive protein quartiles were linearly associated with both CVD and all-cause mortality (P < 0.001), even after adjustment for known CVD risk factors. Regardless of baseline C-reactive protein concentration, any increase or decrease in C-reactive protein over time did not affect the HR for all-cause, or CVD mortality. Models with C-reactive protein yielded a net reclassification improvement for CVD mortality of 24.9% (P = 0.04) for individuals with intermediate risk.
  
  
  CONCLUSIONS
  C-reactive protein concentrations are substantially lower in Koreans than reported for whites populations. Nonetheless, C-reactive protein levels are associated with CVD and all-cause mortality in Korean men. Standard cut points for C-reactive protein may under-represent Asians at risk for CVD.
authors.affiliation: Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea kcmd.sung@samsung.com.
authors.forename: Ki-Chul
authors.initials: KC
authors.lastname: Sung
authors.affiliation: Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
authors.forename: Seungho
authors.initials: S
authors.lastname: Ryu
authors.affiliation: Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
authors.forename: Yoosoo
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Nutrition and Metabolism Unit, IDS Building, Southampton General Hospital, University of Southampton and Southampton National Institute for Health Research Biomedical Research Centre, Southampton MP 887, UK.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Byrne
authors.affiliation: Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Sun H
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000401:mortality*; D002423:Cause of Death; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D056910:Republic of Korea / Q000453:epidemiology / Q000208:ethnology; D017678:Sex Distribution
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: C-reactive protein; Cardiovascular and all-cause mortality; Cardiovascular risk factors