C-Reactive Protein Identifies Low-Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer-Norfolk Prospective Population Study.
Conflicting data exist about the cardiovascular risk of metabolically healthy obese persons. The prognostic value of C-reactive protein (CRP) in this intriguing group is unknown. We assessed the association between CRP levels and the risk of coronary heart disease (CHD) in metabolically healthy persons with abdominal obesity.



In the European Prospective Investigation of Cancer-Norfolk prospective cohort, CRP levels and information on metabolic syndrome criteria were available for 7279 participants, of whom 825 (11%) developed CHD during a follow-up period of 10.9±1.8 years. There was a trend toward a higher multivariable-adjusted hazard ratio for CHD in metabolically healthy obese participants with CRP levels >2 mg/L compared with <2 mg/L (hazard ratio 1.59, 95% CI 0.97-2.62, P=0.066). Metabolically unhealthy obese participants had significantly higher CHD risk compared with metabolically healthy obese participants with CRP levels <2 mg/L (hazard ratio 1.88, 95% CI 1.20-2.94, P=0.006). Most important, we found that the risk of CHD among metabolically healthy obese persons with CRP levels <2 mg/L was comparable to that of metabolically healthy nonobese persons (hazard ratio 0.91, 95% CI 0.60-1.39, P=0.674).



Among metabolically healthy obese persons, low CRP levels were associated with a CHD risk comparable to that of metabolically healthy nonobese persons. CRP appears to be an easy and widely available method for identifying a low-risk subpopulation among metabolically healthy obese persons.
Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands dfvanwijk@gmail.com.
Diederik F
DF
van Wijk
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
S Matthijs
SM
Boekholdt
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada.
Benoit J
BJ
Arsenault
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, United Kingdom.
Sara
S
Ahmadi-Abhari
Medical Research Council Epidemiology Unit, Cambridge, United Kingdom.
Nicholas J
NJ
Wareham
Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Erik S G
ES
Stroes
Medical Research Council Epidemiology Unit, Cambridge, United Kingdom.
Kay-Tee
KT
Khaw
D002097:C-Reactive Protein / Q000378:metabolism*; D003327:Coronary Disease / Q000097:blood / Q000209:etiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood; D056128:Obesity, Abdominal / Q000097:blood / Q000150:complications; D000067329:Obesity, Metabolically Benign / Q000097:blood / Q000150:complications*; D011446:Prospective Studies; D012307:Risk Factors
D002097:C-Reactive Protein; D006442:Glycated Hemoglobin
atherosclerosis; inflammation; metabolic syndrome; obesity; risk factor