C-reactive protein is associated with disability independently of vascular events: the Northern Manhattan Study
Mandip S Dhamoon1, Ying-Kuen Cheung2, Yeseon P Moon2
1Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA.
Insights
Higher levels of high-sensitivity C-reactive protein (CRP), a marker of inflammation, are linked to greater baseline disability. This association persists even after accounting for cardiovascular risk factors and events, suggesting inflammation impacts function independently.
Area of Science:
- Cardiovascular epidemiology
- Inflammation and chronic disease
- Geriatric medicine
Background:
- High-sensitivity C-reactive protein (CRP) is a known marker for cardiovascular events and mortality.
- The relationship between CRP and long-term functional status trajectories remains incompletely understood.
- Systemic inflammation's independent role in functional decline requires further investigation.
Purpose of the Study:
- To investigate the association between serum high-sensitivity C-reactive protein (CRP) levels and functional status.
- To determine if CRP is associated with baseline disability and changes in function over time.
- To assess these associations independently of traditional vascular risk factors and major cardiovascular events.
Main Methods:
- A prospective, population-based cohort study (Northern Manhattan Study) was conducted.
- Participants aged 40 years and older, free of stroke at baseline, were followed for a median of 13 years.
- Annual functional status assessments using the Barthel index (BI) were performed, with baseline CRP levels and covariates analyzed using generalized estimating equations.
Main Results:
- The study included 2,240 participants with a mean age of 69 years; 36% were male.
- Higher baseline serum CRP levels were significantly associated with greater baseline disability (lower Barthel index scores).
- No significant association was found between CRP levels and the change in functional status over the follow-up period.
Conclusions:
- Elevated serum CRP levels are independently associated with higher baseline disability in a general population.
- Systemic inflammation, as indicated by CRP, may contribute to functional limitations beyond established clinical vascular events.
- These findings highlight the potential role of inflammation in the pathophysiology of disability.
Background:
High-sensitivity C-reactive protein (CRP) has been associated with cardiovascular events and mortality, but the association of CRP with functional status is not well defined. We hypothesised that serum levels of high-sensitivity CRP are associated with long-term trajectories of functional status independently of vascular risk factors and stroke and myocardial infarction (MI) occurring during follow-up.
Design:
Prospective, population-based.
Setting:
Northern Manhattan Study.
Participants:
Stroke-free participants aged ≥40 years.
Measurements:
Annual assessments of disability with the Barthel index (BI) for a median of 13 years. BI was analysed as a continuous variable (range 0–100). Baseline demographics, risk factors and laboratory studies were collected, including CRP (n = 2,240). Separate generalised estimating equation models estimated standardised associations between CRP and (i) baseline functional status and (ii) change in function over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up.
Results:
Mean age was 69 (SD 10) years, 36% were male, 55% Hispanic, 75% hypertensive and 21% diabetic; 337 MIs and 369 first strokes occurred during follow-up. Mean CRP level was 5.24 mg/l (SD 8.86). logCRP was associated with baseline BI (−0.34 BI points per unit logCRP, 95% confidence interval −0.62, −0.06) but not with change over time.
Conclusions:
In this large population-based study, higher serum CRP levels were associated with higher baseline disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up. Systemic inflammation may contribute to disability independently of clinical vascular events.
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