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High-sensitivity C-reactive protein and cardiovascular events in a multi-ethnic cohort: the HELIUS study
Cheyenne Y Y Beverloo1, Maxim E Annink1, Jordan M Kraaijenhof1
1Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Insights
High-sensitivity C-reactive protein (hsCRP) is linked to cardiovascular risk in Europeans and Africans, but not South Asians. This suggests a need for new inflammatory biomarkers for South Asian cardiometabolic risk assessment.
Area of Science:
- Cardiovascular epidemiology
- Inflammation biomarkers
- Multi-ethnic health disparities
Background:
- Elevated high-sensitivity C-reactive protein (hsCRP) is a known risk factor for atherosclerotic cardiovascular disease.
- This association requires further investigation in diverse populations, particularly South Asians, who face a higher cardiometabolic risk.
Purpose of the Study:
- To investigate ethnic variations in hsCRP levels and its association with cardiovascular events.
- To assess the predictive value of hsCRP for cardiovascular risk across different ethnic groups within the HEalthy Life In an Urban Setting (HELIUS) study.
Main Methods:
- A general population study including 14,663 participants of Dutch, South Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan origin.
- Collected mortality and cardiovascular event data from nationwide registries.
- Analyzed differences in hsCRP levels and its association with cardiovascular events across ethnic groups.
Main Results:
- South Asian participants exhibited higher median hsCRP levels (1.6 mg/L) compared to European (1.0 mg/L) and African (1.3 mg/L) participants (p <0.001).
- hsCRP was associated with cardiovascular events in European (aHR 1.08) and African (aHR 1.09) participants.
- No significant association between hsCRP and cardiovascular events was found in South Asian participants, despite their highest event rate.
Conclusions:
- hsCRP predicts cardiovascular events in individuals of European and African descent but not in South Asians.
- Higher hsCRP levels in South Asians did not correlate with increased cardiovascular events, highlighting a potential limitation of hsCRP as a sole biomarker.
- Alternative inflammatory biomarkers are needed for accurate cardiometabolic risk assessment in South Asian populations.
Aim:
Elevated high-sensitivity C-reactive protein (hsCRP) concentrations are associated with an increased atherosclerotic cardiovascular risk, but this has not been extensively investigated in multi-ethnic populations, including South Asians, who are characterized by an increased cardiometabolic risk.
Methods:
In this general population study we included 14,663 participants from the HEalthy Life In an Urban Setting (HELIUS) study (Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin). Mortality and cardiovascular event data were collected from nationwide registries. Differences in hsCRP levels and the association between hsCRP and cardiovascular events across the ethnic groups were assessed.
Results:
The mean age was 44±13 years, 55% were female. Median hsCRP at baseline was 1.0 (0.5-2.1) mg/L in the European, 1.3 (0.6-2.7) mg/L in the African, and 1.6 (0.7-3.3) mg/L in the South Asian participants (p <0.001). A total number of 568 cardiovascular events were recorded over a median follow-up time of 8.8 (7.8-9.7) years. hsCRP was associated with cardiovascular events in the European and African participants (adjusted HR per 1 mg/L increase in hsCRP: 1.08 [95% CI 1.00-1.16]; and 1.09 [95% CI 1.03-1.16], respectively), but not in the South Asian participants, despite having the highest event rate.
Conclusions:
hsCRP was associated with incident cardiovascular events in individuals of European and African descent but not in South Asian individuals, despite higher hsCRP values. These findings suggest the need to find alternative inflammatory biomarkers to allow for a more reliable assessment of the increased cardiometabolic risk in South Asian individuals.
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