Gender and C-reactive Protein
Gender and C-reactive Protein
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.
Recent American Heart Association/Centers for Disease Control and Prevention (AHA/CDC) guidelines support the measurement of highly sensitive C-reactive protein (CRP) to further risk stratify individuals at intermediate risk for heart disease (10%-20% 10-year risk). However, the guidelines make no distinction between gender when establishing CRP cut points. C-reactive protein has been shown to independently predict cardiovascular events in both men and women. However, women have higher CRP levels but are at lower risk for cardiovascular events compared with men. Therefore, using a CRP cutoff of ≥3 mg/L to define high risk may not be an optimal strategy for women.
The AHA/CDC guidelines recommend further research to address discrepancies in current knowledge concerning CRP levels in population subgroups. In this article, we report gender differences in CRP concentration in a multiethnic population of 6814 men and women aged 45 to 84 years enrolled in MESA.
Abstract and Introduction
Abstract
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.
Introduction
Recent American Heart Association/Centers for Disease Control and Prevention (AHA/CDC) guidelines support the measurement of highly sensitive C-reactive protein (CRP) to further risk stratify individuals at intermediate risk for heart disease (10%-20% 10-year risk). However, the guidelines make no distinction between gender when establishing CRP cut points. C-reactive protein has been shown to independently predict cardiovascular events in both men and women. However, women have higher CRP levels but are at lower risk for cardiovascular events compared with men. Therefore, using a CRP cutoff of ≥3 mg/L to define high risk may not be an optimal strategy for women.
The AHA/CDC guidelines recommend further research to address discrepancies in current knowledge concerning CRP levels in population subgroups. In this article, we report gender differences in CRP concentration in a multiethnic population of 6814 men and women aged 45 to 84 years enrolled in MESA.
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