High-sensitivity C-reactive protein predicts mortality but not stroke: the Northern Manhattan Study

Area of Science:

• Cardiovascular epidemiology
• Inflammatory markers
• Stroke and vascular disease research

Background:

• Inflammation markers are linked to myocardial infarction (MI) risk.
• The association between inflammation markers and stroke risk is debated.
• Prospective cohort studies are crucial for understanding disease prediction.

Purpose of the Study:

• To investigate the predictive value of high-sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA) for stroke, vascular events, and mortality.
• To assess the role of these inflammatory markers in a multiethnic population.
• To clarify the controversial association between inflammation and stroke risk.

Main Methods:

• Prospective cohort study of stroke-free adults (aged >=40 years) from the Northern Manhattan Study.
• Measurement of hsCRP and SAA using nephelometry.
• Cox proportional hazards models to determine hazard ratios (HR) and 95% confidence intervals (CI) for outcomes, adjusting for demographics and risk factors.

Main Results:

• hsCRP >3 mg/L was not significantly associated with ischemic stroke risk after full adjustment (adjusted HR = 1.20, 95% CI 0.78-1.86).
• Elevated hsCRP (>3 mg/L) was associated with increased risk of myocardial infarction (adjusted HR = 1.70, 95% CI 1.04-2.77) and all-cause mortality (adjusted HR = 1.55, 95% CI 1.23-1.96).
• Serum amyloid A (SAA) showed no association with stroke risk in this cohort.

Conclusions:

• In this multiethnic cohort, hsCRP is not a significant predictor of ischemic stroke but shows a modest association with myocardial infarction and mortality.
• The predictive utility of hsCRP and SAA may be influenced by population-specific characteristics, including age and the presence of other risk factors.
• Further research is needed to elucidate the role of inflammatory markers in diverse populations and their specific associations with cardiovascular outcomes.