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High-sensitivity C reactive protein and risk of cardiovascular disease in China-CVD study
  1. Ying Dong,
  2. Xin Wang,
  3. Linfeng Zhang,
  4. Zuo Chen,
  5. Congyi Zheng,
  6. Jiali Wang,
  7. Yuting Kang,
  8. Lan Shao,
  9. Ye Tian,
  10. Zengwu Wang
  11. for the China CVD study investigators
    1. Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Pecking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
    1. Correspondence to Dr. Zengwu Wang, Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Pecking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China; wangzengwu{at}


    Background This study aimed to assess the association of high sensitivity C-reactive protein (hs-CRP) with cardiovascular disease (CVD) in middle-aged Chinese population.

    Methods The baseline was collected 2009–2010, and follow-up was conducted in 2016–2017. Data of hs-CRP were from baseline examination and re-examination in 2016–2017 using transmission turbidimetry with a measurement range of 0–42 000. The primary outcome was CVD including coronary heart disease events and stroke events.

    Results Among 8688 participants free from CVD (at baseline, mean age, 50.1 years, 3897 were males), there were 189 CVD events, occurred during a median follow-up of 6.34 years (54 685 person-years at risk). From the Kaplan-Meier curve, we found that there was a progressive increase in CVD event rates by hs-CRP tertiles (log-rank test, p<0.001). Baseline hs-CRP was linearly associated with CVD (p for trend=0.015) even after adjusting for known CVD risk factors. Furthermore, the net reclassification improvement when hs-CRP was added to a model based on traditional factors was 7.85% for CVD (p=0.003). In addition, the correlation between change of hs-CRP and CVD was conducted in a subgroup (n=4778). However, we did not find the correlation between hs-CRP change and CVD (correlation coefficient: −0.003, p=0.846).

    Conclusions In the middle-aged Chinese population, hs-CRP was associated with increased risk of developing CVD. Although there was no correlation between hs-CRP change and CVD, the level of hs-CRP was higher at follow-up than baseline even among those with CVD. More attention should be given to those with higher level of hs-CRP for CVD prevention.

    • cohort studies
    • cardiovascular disease
    • epidemiology

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    • Patient consent for publication Not required.

    • Contributors YD researched data, conducted data analyses, interpreted results and prepared the manuscript. XW, LZ and ZC conceptualised the study, aided in data analysis and critically revised the manuscript. CZ, JW, YK, LS and YT aided in result interpretation and critically revised the manuscript. ZW conceptualised the study, researched and critically revised the manuscript. All authors have read and approved the final version of the manuscript.

    • Funding This study was supported by the National Natural Science Foundation of China (81373070) and Chinese National Specific Fund for Health-scientific Research in Public Interest (200902001) and CAMS Innovation Fund for Medical Sciences (2017-I2M-1-004).

    • Competing interests None declared.

    • Ethics approval Ethics Review Board of Fuwai hospital approved this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Investigators of China-CVD study: For a partial listing of colleagues see the follows (provinces sorted as alphabetical order): Huiqing Cao, Xiaoxia Wang and Tian Fang, Institute of Molecular Medicine, Pecking University, Beijing, China; Xiaoyan Han and Zhe Li, Chaoyang District Center for Disease Control and Prevention, Beijing, China. Heilongjiang: Ye Tian, Lihang Dong, Fengyu Sun and Fucai Yuan, First Affiliated Hospital of Harbin Medical University, Heilongjiang, China. Jiangsu: Xin Zhou, Yunyang Zhu, Yi He and Qingping Xi, Jintan Institute of Hygiene, Jiangsu, China. Shanxi: Ruihai Yang, Jun Yang, Yong Ren, Maiqi Dan, Yiyue Wang, Daming Yu and Ru Ju, Hanzhong Hospital, Shanxi, China. Shanxi: Dongshuang Guo, Yuxian Hospital, Shanxi, China. Sichuan: Dahua Tan, Zhiguo Zheng, Jingjing Zheng and Yang Xu, Deyang Institute of Hygiene, Sichuan, China. Xinjiang: Dongsheng Wang and Tao Chen, Autonomous Region Yining Center for Disease Control and Prevention, Xinjiang Uygur Autonomous Region, China. Yunnan: Meihui Su and Yongde Zhang, Yunnan Center for Disease Prevention and Control, Yunnan, China. Zhejiang: Zhanhang Sun and Chen Dai, Zhoushan Cardiovascular Institute, Zhejiang, China.