title: Repeated measures of body mass index and C-reactive protein in relation to all-cause mortality and cardiovascular disease: results from the consortium on health and ageing network of cohorts in Europe and the United States (CHANCES).
abstract: Obesity has been linked with elevated levels of C-reactive protein (CRP), and both have been associated with increased risk of mortality and cardiovascular disease (CVD). Previous studies have used a single 'baseline' measurement and such analyses cannot account for possible changes in these which may lead to a biased estimation of risk. Using four cohorts from CHANCES which had repeated measures in participants 50 years and older, multivariate time-dependent Cox proportional hazards was used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) to examine the relationship between body mass index (BMI) and CRP with all-cause mortality and CVD. Being overweight (≥25-<30 kg/m(2)) or moderately obese (≥30-<35) tended to be associated with a lower risk of mortality compared to normal (≥18.5-<25): ESTHER, HR (95 % CI) 0.69 (0.58-0.82) and 0.78 (0.63-0.97); Rotterdam, 0.86 (0.79-0.94) and 0.80 (0.72-0.89). A similar relationship was found, but only for overweight in Glostrup, HR (95 % CI) 0.88 (0.76-1.02); and moderately obese in Tromsø, HR (95 % CI) 0.79 (0.62-1.01). Associations were not evident between repeated measures of BMI and CVD. Conversely, increasing CRP concentrations, measured on more than one occasion, were associated with an increasing risk of mortality and CVD. Being overweight or moderately obese is associated with a lower risk of mortality, while CRP, independent of BMI, is positively associated with mortality and CVD risk. If inflammation links CRP and BMI, they may participate in distinct/independent pathways. Accounting for independent changes in risk factors over time may be crucial for unveiling their effects on mortality and disease morbidity.
authors.affiliation: UKCRC Centre of Excellence for Public Health for Northern Ireland, School of Medicine and Dentistry, Queens University Belfast, Grosvenor Road, Belfast, UK, BT12 6BJ, Northern Ireland, m.odoherty@qub.ac.uk.
authors.forename: Mark G
authors.initials: MG
authors.lastname: O'Doherty
authors.forename: Torben
authors.initials: T
authors.lastname: Jørgensen
authors.forename: Anders
authors.initials: A
authors.lastname: Borglykke
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.forename: Ben
authors.initials: B
authors.lastname: Schöttker
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.forename: Galatios
authors.initials: G
authors.lastname: Siganos
authors.forename: Maryam
authors.initials: M
authors.lastname: Kavousi
authors.forename: Maria
authors.initials: M
authors.lastname: Hughes
authors.forename: Aysel
authors.initials: A
authors.lastname: Müezzinler
authors.forename: Bernd
authors.initials: B
authors.lastname: Holleczek
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D002097:C-Reactive Protein