title: Association Between High-Sensitivity C-Reactive Protein and Total Stroke by Hypertensive Status Among Men.
abstract: BACKGROUND
  High-sensitivity C-reactive protein (hsCRP), a marker of systemic inflammation, may promote atherosclerosis, particularly among adults with elevated blood pressure; however, data are sparse. We examined the association between hsCRP concentrations and risk of total stroke by hypertension status (normotension, prehypertension, and hypertension) among men in the Physicians' Health Study (PHS).
  
  
  RESULTS
  Blood samples were collected (1996-1997) and assayed for hsCRP among 10 456 initially healthy men from PHS I and PHS II and followed from 1997 to 2012. Self-reported hypertension status, cardiovascular risk factors, lifestyle, and alcohol consumption were obtained from the baseline questionnaire prior to randomization in PHS II. Strokes were updated approximately annually and confirmed by medical records according to the National Survey of Stroke criteria. Multivariable Cox models were used. We observed 395 incident total strokes over 115 791 person-years. In analyses adjusted for potential confounders and stroke risk factors, clinically elevated hsCRP (>3 mg/L) was associated with a 40% significantly greater hazard of total stroke compared with hsCRP <1 mg/L (hazard ratio 1.40, 95% CI 1.06 to 1.87; Ptrend=0.01). Additional adjustment for blood pressure and biomarkers associated with cardiovascular risk marginally attenuated the estimates. Results were similar by hypertension status, although not statistically significant among normotensive and prehypertensive participants due to limited events.
  
  
  CONCLUSIONS
  Elevated hsCRP levels were associated with a greater risk of total stroke, even after adjustment for potential confounders and cardiovascular risk factors. Risk of total stroke was significantly higher among hypertensive men with elevated hsCRP compared with normotensive men with low hsCRP.
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C.J., K.M.R., R.J.G., P.R., M.G., H.D.S.).
authors.forename: Monik C
authors.initials: MC
authors.lastname: Jiménez
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C.J., K.M.R., R.J.G., P.R., M.G., H.D.S.).
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rexrode
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C.J., K.M.R., R.J.G., P.R., M.G., H.D.S.) Department of Biostatistics, Harvard School of Public Health, Boston, MA (R.J.G.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C.J., K.M.R., R.J.G., P.R., M.G., H.D.S.).
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ridker
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C.J., K.M.R., R.J.G., P.R., M.G., H.D.S.) Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.G., H.D.S.).
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.C.J., K.M.R., R.J.G., P.R., M.G., H.D.S.) Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.D.S.) Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.G., H.D.S.).
authors.forename: Howard D
authors.initials: HD
authors.lastname: Sesso
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein
keywords: high‐sensitivity C‐reactive protein; hypertension; ischemic stroke; prehypertension