Abstract
BackgroundWe aimed to prospectively evaluate the associations between the baseline and changes in high-density C-reactive protein (hs-CRP) and incident metabolic syndrome (MetS) in China and update the evidence based on a meta-analysis of cohort studies in different populations.MethodsData from the China Health and Retirement Longitudinal Study among adults aged 45 years or older were analyzed. Participants who were recruited in the study in 2011–2012 without MetS and successfully followed up to 2015–2016 were included in our final analysis. Logistic regressions were applied to examine the prospective associations of baseline and changes in hs-CRP with incident MetS and estimate corresponding odds ratios (ORs) and 95% confidence intervals (95% CIs). A meta-analysis was conducted to synthesize effect estimates from our findings and other cohort studies on this topic.ResultsAmong 4,116 participants, 535 developed MetS after a 4-year follow-up. Compared with the participants with hs-CRP in the lowest quartile, those with hs-CRP in the second, third, and highest quartiles had higher odds of MetS, with multivariable-adjusted ORs (95% CIs) of 1.51 (1.12, 2.06), 1.50 (1.11, 2.04), and 1.83 (1.37, 2.47). For the hs-CRP changes, ORs (95% CIs) were 3.24 (2.51, 4.02), 3.34 (2.56, 4.38), and 3.34 (2.54, 4.40) respectively. One unit (log of 1 mg/L) increase in hs-CRP was associated with 23% higher risk of MetS (OR 1.23; 95% CI 1.10, 1.38). In a meta-analysis of 6 cohort studies, the pooled relative risk for MetS was 1.63 (1.38, 1.93) for the highest versus lowest level of hs-CRP. In addition, the pooled relative risk for MetS was 1.29 (1.05, 1.59) for each unit increase of hs-CRP after log-transformation.ConclusionsBoth higher baseline hs-CRP and longitudinal hs-CRP increases were associated with higher risks of incident MetS. Individuals with high hs-CRP levels may need to be closely monitored for future risk of MetS.
Highlights
We aimed to prospectively evaluate the associations between the baseline and changes in high-den‐ sity C-reactive protein and incident metabolic syndrome (MetS) in China and update the evidence based on a meta-analysis of cohort studies in different populations
Most extant cohort studies were conducted in non-Chinese populations, and one cohort study among 886 southern Chinese adults with a five-year follow-up found that a high high-den‐ sity C-reactive protein (hs-CRP) level was related with an increased risk of incident MetS [6]
These findings suggest that longitudinal changes, sustained elevations of hs-CRP may carry extra information for chronic inflammation compared with single hs-CRP measurements
Summary
We aimed to prospectively evaluate the associations between the baseline and changes in high-den‐ sity C-reactive protein (hs-CRP) and incident metabolic syndrome (MetS) in China and update the evidence based on a meta-analysis of cohort studies in different populations. One study from the US showed increased risks of incident diabetes, cardiovascular disease, and mortality in relation to sustained elevated hs-CRP [8], while a separate study from China found that adults with “moderate-increased” hs-CRP (moderate at baseline and increased to high concentration at follow-ups) had a higher risk of incident diabetes, compared with those with “low-stable” hs-CRP (low at baseline and maintained at low concentration at follow-ups) [9] These findings suggest that longitudinal changes, sustained elevations of hs-CRP may carry extra information for chronic inflammation compared with single hs-CRP measurements. Given the high prevalence of MetS (24.5%) in Chinese adults [10], it is necessary to systematically assess the link of hs-CRP to MetS risk using national population-based longitudinal data in China
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