Open AccessAssociation Between High‐Sensitivity C‐Reactive Protein and Total Stroke by Hypertensive Status Among Men
Author(s) -
Jiménez Monik C.,
Rexrode Kathryn M.,
Glynn Robert J.,
Ridker Paul M,
Gaziano J. Michael,
Sesso Howard D.
Publication year - 2015
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.115.002073
Subject(s) - medicine , stroke (engine) , blood pressure , hazard ratio , confounding , prehypertension , c reactive protein , proportional hazards model , national health and nutrition examination survey , confidence interval , inflammation , population , environmental health , mechanical engineering , engineering
Background High‐sensitivity C‐reactive protein (hs CRP ), a marker of systemic inflammation, may promote atherosclerosis, particularly among adults with elevated blood pressure; however, data are sparse. We examined the association between hs CRP concentrations and risk of total stroke by hypertension status (normotension, prehypertension, and hypertension) among men in the Physicians’ Health Study ( PHS ). Methods and Results Blood samples were collected (1996–1997) and assayed for hs CRP among 10 456 initially healthy men from PHS I and PHS II and followed from 1997 to 2012. Self‐reported hypertension status, cardiovascular risk factors, lifestyle, and alcohol consumption were obtained from the baseline questionnaire prior to randomization in PHS II . Strokes were updated approximately annually and confirmed by medical records according to the National Survey of Stroke criteria. Multivariable Cox models were used. We observed 395 incident total strokes over 115 791 person‐years. In analyses adjusted for potential confounders and stroke risk factors, clinically elevated hs CRP (>3 mg/L) was associated with a 40% significantly greater hazard of total stroke compared with hs CRP <1 mg/L (hazard ratio 1.40, 95% CI 1.06 to 1.8 7 ; P trend =0.01). Additional adjustment for blood pressure and biomarkers associated with cardiovascular risk marginally attenuated the estimates. Results were similar by hypertension status, although not statistically significant among normotensive and prehypertensive participants due to limited events. Conclusions Elevated hs CRP levels were associated with a greater risk of total stroke, even after adjustment for potential confounders and cardiovascular risk factors. Risk of total stroke was significantly higher among hypertensive men with elevated hs CRP compared with normotensive men with low hs CRP .