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C-reactive protein and stroke risk in blacks and whites: The REasons for Geographic And Racial Differences in Stroke
Christina R Evans1, D Leann Long2, George Howard2
1Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
Insights
C-reactive protein (CRP) levels show a different association with ischemic stroke risk in Black and White individuals. Higher CRP is linked to increased stroke risk in Whites at lower levels than in Blacks.
Area of Science:
- Cardiovascular epidemiology
- Biomarkers of inflammation
- Stroke risk stratification
Background:
- C-reactive protein (CRP) is a key inflammatory biomarker for vascular risk prediction.
- Existing data on CRP's role in risk prediction is limited in people of color.
- Blacks exhibit higher stroke incidence and CRP levels compared to Whites.
Purpose of the Study:
- To investigate the association between C-reactive protein (CRP) levels and ischemic stroke risk.
- To compare this association across different racial groups (Blacks and Whites).
Main Methods:
- Utilized data from the REGARDS observational cohort study, including 30,239 Black and White American adults aged 45+.
- Followed participants for incident ischemic stroke over 6.9 years.
- Calculated hazard ratios for ischemic stroke across CRP categories (<1, 1-3, 3-10, and ≥10 mg/L), adjusting for age, sex, and stroke risk factors.
Main Results:
- Observed 292 incident ischemic strokes in Blacks and 439 in Whites.
- In Whites, elevated stroke risk was seen for CRP 3-10 mg/L and >10 mg/L; in Blacks, risk was elevated only for CRP >10 mg/L.
- Adjusted hazard ratios per SD higher lnCRP were 1.18 overall, 1.14 in Blacks, and 1.22 in Whites, confirming a race-dependent association.
Conclusions:
- C-reactive protein (CRP) may have differential utility in assessing ischemic stroke risk between Black and White populations.
- Further research is needed to confirm these findings for stroke and extend them to coronary heart disease.
- Investigating the underlying reasons for observed racial differences in CRP's association with stroke is crucial.
Background:
C-reactive protein (CRP) is an inflammatory biomarker used in vascular risk prediction, though with less data in people of color. Blacks have higher stroke incidence and also higher CRP than whites. We studied the association of CRP with ischemic stroke risk in blacks and whites.
Methods:
REGARDS, an observational cohort study, recruited and followed 30,239 black and white Americans 45 years and older for ischemic stroke. We calculated hazard ratios and 95% CIs of ischemic stroke by CRP category (<1, 1-3, 3-10, and ≥10 mg/L) adjusted for age, sex and stroke risk factors.
Results:
There were 292 incident ischemic strokes among blacks and 439 in whites over 6.9 years of follow-up. In whites, the risk was elevated for CRP in the range from 3 to 10 mg/L and even higher for CRP >10 mg/L, whereas in blacks, an association was only seen for CRP >10 mg/L. Considered as a continuous variable, the risk factor-adjusted hazard ratios per SD higher lnCRP were 1.18 (95% CI 1.09-1.28) overall, 1.14 (95% CI 1.00-1.29) in blacks, and 1.22 (95% CI 1.10-1.35) in whites. Spline regression analysis visually confirmed the race difference in the association.
Conclusions:
CRP may not be equally useful in stroke risk assessment in blacks and whites. Confirmation, similar study for coronary heart disease, and identification of reasons for these racial differences require further study.
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