Elsevier

American Heart Journal

Volume 152, Issue 3, September 2006, Pages 593-598
American Heart Journal

Clinical Investigation
Prevention and Rehabilitation
Gender and C-reactive protein: Data from the Multiethnic Study of Atherosclerosis (MESA) cohort

https://doi.org/10.1016/j.ahj.2006.02.015Get rights and content

Background

American Heart Association/Centers for Disease Control and Prevention guidelines support the measurement of C-reactive protein (CRP) to further risk stratify individuals at intermediate risk (10%-20% 10-year risk) for heart disease. Determining gender-specific differences in CRP may alter how CRP levels are interpreted and used to determine risk.

Methods

MESA is a prospective cohort consisting of 6814 men and women aged 45 to 84 years recruited from 6 US communities. Nonparametric analyses were performed to determine differences in CRP levels by gender in the entire cohort and after stratifying by use of estrogen medication (n = 944). Stratifying by median body mass index (BMI) and generalized linear models were also used to account for confounding variables associated with CRP.

Results

Overall, women had substantially higher median CRP levels compared with men (2.56 vs 1.43 mg/L, P < .0001). After excluding women using estrogen and individuals with CRP >10 mg/L, median CRP levels remained higher in women compared with men (1.85 vs 1.33 mg/L, P < .0001). When participants were stratified into high and low BMI groups, the gender difference in CRP levels remained. This pattern of higher CRP levels in women was consistent across all ethnic subgroups even after multivariable adjustment.

Conclusions

C-reactive protein levels were higher in women compared with men despite accounting for BMI and other common confounding variables. This gender difference was maintained across all ethnic subgroups. These results suggest that evaluation of gender-specific CRP cut points to determine cardiovascular risk should be considered.

Section snippets

Methods

MESA was initiated in July 2000 to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease in individuals without known cardiovascular disease.5 This prospective cohort study includes 6814 men and women aged 45 to 84 years, without a known history of cardiovascular disease, recruited from 6 US communities (Baltimore, MD; Chicago, IL; Forsyth County, NC; Los Angeles County, CA; Northern Manhattan, NY; and St Paul, MN). The study consists of 47% men with a

Statistical analysis

Comparison of baseline characteristics between men and women was determined by χ2 tests and simple t tests. Nonparametric 1-way analysis of variance, using Wilcoxon scores, was performed to determine differences in CRP levels by gender in the entire cohort. Similar analyses were performed after stratifying by use of estrogen medication (n = 944) and after excluding individuals with CRP levels >10 mg/L (n = 575). Body mass index was treated as a dichotomous variable after dividing on the median

Results

The MESA cohort, with a mean age of 62 years at the baseline examination, consisted of 3601 women and 3213 men (Table I). Ethnic groups were equally represented across gender. Women were more likely to have an elevated BMI, whereas men were more likely to smoke, use alcohol, have diabetes, take aspirin, and exercise.

The overall distribution of CRP by gender is shown in Figure 1. In the MESA cohort, a CRP cutoff of 3 mg/L represented the 55th percentile in women and the 75th percentile in men.

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This research was supported by contracts N01-HC-95159 through N01-HC-95166 from the National Heart, Lung, and Blood Institute (NHLBI), Bethesda, MD, and NHLBI research training grant 1 T32 HL076132-01.

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