Related Experiment Video
Updated: Jun 8, 2026
Dried Blood Spot Collection of Health Biomarkers to Maximize Participation in Population Studies
Published on: January 28, 2014
Ancestry as a determinant of mean population C-reactive protein values: implications for cardiovascular risk
Tina Shah1, Paul Newcombe, Liam Smeeth
1Centre for Clinical Pharmacology, University College London, United Kingdom. t.shah@ucl.ac.uk
Insights
Population C-reactive protein (CRP) levels vary significantly by ancestry, impacting eligibility for cardiovascular disease prevention with rosuvastatin. A single CRP threshold may lead to inequities in statin access for diverse populations.
Area of Science:
- Cardiovascular disease prevention
- Population health
- Genetics and ancestry
Background:
- Rosuvastatin eligibility for cardiovascular disease prevention is based on C-reactive protein (CRP) concentration >2 mg/L.
- Most studies on CRP and cardiovascular disease have focused on European populations.
- This study investigates how ancestry influences population CRP concentrations and statin targeting in non-European individuals.
Purpose of the Study:
- To evaluate the influence of ancestry on population CRP concentration.
- To assess the implications of these differences for statin targeting in non-European populations.
- To determine if a single CRP threshold for cardiovascular risk prediction leads to inequities in statin eligibility.
Main Methods:
- Systematic review and meta-analysis of 89 studies involving 221,287 individuals.
- Analysis of CRP concentrations across different ancestral groups including Black Americans, Hispanics, South Asians, Whites, and East Asians.
- Examination of CRP polymorphisms and their association with CRP concentration and coronary heart disease events across ancestries.
- Analysis of participant data from the Wandsworth Heart and Stroke Study.
Main Results:
- Geometric mean CRP concentrations varied significantly by ancestry, with East Asians having the lowest (1.01 mg/L) and US Blacks the highest (2.6 mg/L).
- These differences persisted after adjusting for age and body mass index and were not explained by study design or CRP assay.
- At age 60, fewer than half of East Asians but over two-thirds of Hispanics had CRP values exceeding 2 mg/L.
- While factors like BMI, blood pressure, and smoking contributed to CRP differences, the majority remained unexplained by known risk factors.
Conclusions:
- Ancestral differences in CRP concentration are substantial enough to affect rosuvastatin eligibility based on a 2 mg/L threshold.
- These disparities are only partially explained by traditional cardiovascular risk factors.
- A uniform CRP threshold for cardiovascular risk prediction may result in unequal access to statin therapy, potentially misrepresenting actual cardiovascular risk across diverse populations.
Background:
Eligibility for rosuvastatin treatment for cardiovascular disease prevention includes a C-reactive protein (CRP) concentration >2 mg/L. Most observational studies of CRP and cardiovascular disease have been in Europeans. We evaluated the influence of ancestry on population CRP concentration to assess the implications for statin targeting in non-Europeans.
Methods And Results:
In a systematic review and meta-analysis among 221 287 people from 89 studies, geometric mean CRP was 2.6 mg/L (95% credible interval, 2.27 to 2.96) in blacks resident in the United States (n=18 585); 2.51 mg/L (95% CI, 1.18 to 2.86) in Hispanics (n=5049); 2.34 mg/L (95% CI, 1.99 to 2.8) in South Asians (n=1053); 2.03 mg/L (95% CI, 1.77 to 2.3) in whites (n=104 949); and 1.01 mg/L (95% CI, 0.88 to 1.18) in East Asians (n=39 521). Differences were not explained by study design or CRP assay and were preserved after adjustment for age and body mass index. At age 60 years, fewer than half of East Asians but more than two thirds of Hispanics were estimated to have CRP values exceeding 2 mg/L. HapMap frequencies of CRP polymorphisms known to associate with CRP concentration but not coronary heart disease events differed by ancestry. In participant data from the Wandsworth Heart and Stroke Study including European, South Asian and African, and Caribbean-descent subjects, body mass index, systolic blood pressure, and smoking contributed to between-group differences in CRP, but the majority of the difference in CRP was unexplained.
Conclusions:
Differences in CRP concentration in populations of diverse ancestry are sufficiently large to affect statin eligibility, based on a single CRP threshold of 2 mg/L, and only partially influenced by differences in variables related to cardiovascular risk. A single threshold value of CRP for cardiovascular risk prediction could lead to inequalities in statin eligibility that may not accurately reflect underlying levels of cardiovascular risk.
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:30Coronary Artery Disease I: Introduction
01:29Cholesterol: Significance and Regulation
Considering cholesterol and...
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:52Regression Toward the Mean