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Association between C reactive protein and all-cause mortality in the ELSA-Brasil cohort
  1. Chams B Maluf1,
  2. Sandhi Maria Barreto2,
  3. Luana Giatti2,
  4. Antonio Luiz Ribeiro3,
  5. Pedro G Vidigal1,
  6. Douglas R M Azevedo4,
  7. Rosane H Griep5,
  8. Sheila Maria Alvim Matos6,
  9. Chen Ji7,
  10. Francesco P Cappuccio7,
  11. Michelle A Miller7
  1. 1 Clinical Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  2. 2 Preventive Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  3. 3 Clinical Hospital and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  4. 4 Department of Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  5. 5 Epidemiology, Oswaldo Cruz Foundation-National School of Public Health, Rio de Janeiro, Brazil
  6. 6 Institute of Public Health, Universidade Federal da Bahia, Salvador, Bahia, Brazil
  7. 7 Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Dr Chams B Maluf, Clinical Pathology, Universidade Federal de Minas Gerais, Belo Horizonte 30130100, Brazil; chamsbm12{at}gmail.com

Abstract

Background High-sensitivity C reactive protein (hsCRP) has been proposed as a marker of incident cardiovascular disease and vascular mortality, and may also be a marker of non-vascular mortality. However, most evidence comes from either North American or European cohorts. The present proposal aims to investigate the association of hsCRP with the risk of all-cause mortality in a multiethnic Brazilian population.

Methods Baseline data (2008–2010) of a cohort of 14 238 subjects participating in the Brazilian Longitudinal Study of Adult Health were used. hsCRP was assayed with immunochemistry. The association of baseline covariates with all-cause mortality was calculated by Cox regression for univariate model and adjusted for different confounders after a mean follow-up of 8.0±1.1 years. The final model was adjusted for age, sex, self-rated race/ethnicity, schooling, health behaviours and prevalent chronic disease.

Results The risk of death increased steadily by quartiles of hsCRP, from 1.45 (95% CI 1.05 to 2.01) in quartile 2 to 1.95 (95% CI 1.42 to 2.69) in quartile 4, compared with quartile 1. Furthermore, the persistence of a significant graded association after the exclusion of deaths in the first year of follow-up suggests that these results are unlikely to be due to reverse causality. Finally, the HR was unaffected by the exclusion of participants who had self-reported medical history of diabetes, cancer and chronic obstructive pulmonary disease.

Conclusions Our study shows that hsCRP level is associated with mortality in a highly admixed population, independent of a large set of lifestyle and clinical variables.

  • epidemiology
  • mortality
  • cohort studies
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Footnotes

  • Contributors CBM, FPC, MM: contributed to design, analysis, acquisition and interpretation, and drafted the manuscript. SMB: contributed to design, analysis, acquisition and interpretation, drafted the manuscript, and critically revised it. LG: contributed to acquisition and interpretation, drafted the manuscript, and critically revised it. ALR, PGV: contributed to interpretation, drafted the manuscript and critically revised it. DRMA, CJ: contributed to design and analysis. RHG, SMAM: contributed to interpretation and critically revised it.

  • Funding The ELSA-Brasil baseline study was supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology (FINEP, Financiadora de Estudos e Projetos and CNPq, National Research Council) (grants 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 06 0071.00 RJ). SMB is a research fellow of the National Research Council (CNPq, grant number 300159/99-4). RHG is also a research fellow of the National Research Council (CNPq, grant number 301807/2016-7). ALR receives research grants from CNPq/Brazil (grants 465518/2014-1 and 310679/2016-8) and from the Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG, Brazil; PPM-00428-17). CBM was supported by a Rutherford Strategic International Fellowship as part of the Universities UK International (UUKi) Rutherford Fund Strategic Partner Grants programme awarded to MM and FPC.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The research protocol was approved by the ethics committee of each participating institution and by the National Research Ethics Committee. All participants signed an informed consent that included permission for the storage of biological samples.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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