Journal of Preventive Medicine and Public Health

Original Articles

C-reactive Protein Concentration Is Associated With a Higher Risk of Mortality in a Rural Korean Population: Jung Hyun Lee, Hyungseon Yeom, Hyeon Chang Kim, Il Suh, Mi Kyung Kim, Min-Ho Shin, Dong Hoon Shin, Sang-Baek Koh, Song Vogue Ahn, Tae-Yong Lee, So Yeon Ryu, Jae-Sok Song, Hong-Soon Choe, Young-Hoon Lee, Bo Youl Choi; J Prev Med Public Health. 2016;49(5):275-287. Published online August 23, 2016; DOI: https://doi.org/10.3961/jpmph.16.025

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Objectives
C-reactive protein (CRP), an inflammatory biomarker, has been widely used as a preclinical marker predictive of morbidity and mortality. Although many studies have reported a positive association between CRP and mortality, uncertainty still remains about this association in various populations, especially in rural Korea.
Methods
A total of 23 233 middle-aged participants (8862 men and 14 371 women) who were free from cardiovascular disease, cancer, and acute inflammation (defined by a CRP level ≥10 mg/L) were drawn from 11 rural communities in Korea between 2005 and 2011. Blood CRP concentration was analyzed as a categorical variable (low: 0.0-0.9 mg/L; intermediate: 1.0-3.0 mg/L; high: 3.1-9.9 mg/L) as well as a continuous variable. Each participant’s vital status through December 2013 was confirmed by death statistics from the National Statistical Office. Cox proportional hazard models were used to assess the independent association between CRP and mortality after adjusting for other risk factors.
Results
The total quantity of observed person-years was 57 975 for men and 95 146 for women, and the number of deaths was 649 among men and 367 among women. Compared to the low-CRP group, the adjusted hazard ratio for all-cause mortality of the intermediate group was 1.17 (95% confidence interval [CI], 0.98 to 1.40) for men and 1.27 (95% CI, 1.01 to 1.61) for women, and the corresponding values for the high-CRP group were 1.98 (95% CI, 1.61 to 2.42) for men and 1.41 (95% CI, 1.03 to 1.95) for women. Similar trends were found for CRP evaluated as a continuous variable and for cardiovascular mortality.
Conclusions
Higher CRP concentrations were associated with higher mortality in a rural Korean population, and this association was more prominent in men than in women.

Summary

Citations

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Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study
Ju-Yeun Lee, Ji Hoon Hong, Sangjun Lee, Seokyung An, Aesun Shin, Sue K. Park, Tariq Jamal Siddiqi
PLOS ONE.2022; 17(6): e0270510. CrossRef
Association of serum high-sensitivity C reactive protein with risk of mortality in an Asian population: the Health Examinees cohort
Sang-Ah Lee, Sung Ok Kwon, Hyerim Park, Xiao-Ou Shu, Jong-Koo Lee, Daehee Kang
BMJ Open.2022; 12(7): e052630. CrossRef
Associations of C-reactive protein and fibrinogen with mortality from all-causes, cardiovascular disease and cancer among U.S. adults
Junxiu Liu, Yanan Zhang, Carl J. Lavie, Fred K. Tabung, Jiting Xu, Qingwei Hu, Lixia He, Yunxiang Zhang
Preventive Medicine.2020; 139: 106044. CrossRef
Sex differences in the association between self-rated health and high-sensitivity C-reactive protein levels in Koreans: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey
Se-Won Park, Seong-Sik Park, Eun-Jung Kim, Won-Suk Sung, In-Hyuk Ha, Boyoung Jung
Health and Quality of Life Outcomes.2020;[Epub] CrossRef

Interaction of Vitamin D and Smoking on Inflammatory Markers in the Urban Elderly: Hyemi Lee, Kyoung-Nam Kim, Youn-Hee Lim, Yun-Chul Hong; J Prev Med Public Health. 2015;48(5):249-256. Published online September 17, 2015; DOI: https://doi.org/10.3961/jpmph.15.042

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Abstract PDF Supplementary Material

Objectives
Epidemiological studies have reported that vitamin D deficiency is associated with inflammatory disease. Smoking is a well-known risk factor for inflammation. However, few studies have investigated the interactive effect of vitamin D deficiency and smoking on inflammation. This study aims to investigate the interaction of vitamin D and smoking with inflammatory markers in the urban elderly.
Methods
We used data from the Korean Elderly Environmental Panel Study, which began in August 2008 and ended in August 2010, and included 560 Koreans ≥60 years old living in Seoul. Data was collected via questionnaires that included items about smoking status at the first visit. Vitamin D levels, high-sensitivity C-reactive protein (hs-CRP), and white blood cell (WBC) counts were repeatedly measured up to three times.
Results
The association of vitamin D and hs-CRP was significant after adjusting for known confounders (β=-0.080, p=0.041). After separate analysis by smoking status, the association of vitamin D deficiency and hs-CRP in smokers was stronger than that in nonsmokers (smokers: β=-0.375, p=0.013; non-smokers: β=-0.060, p=0.150). Smoking status was an effect modifier that changed the association between vitamin D deficiency and hs-CRP (interaction estimate: β=-0.254, p=0.032). Vitamin D was not significantly associated with WBC count (β=0.003, p=0.805).
Conclusions
Vitamin D deficiency was associated with hs-CRP in the urban elderly. Smoking status was an effect modifier of this association. Vitamin D deficiency was not significantly associated with WBC count.

Summary

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Qiongzhang Wang, Zhuoying Zhu, Yuntao Liu, Xinjie Tu, Jincai He
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Evaluation Studies

C-reactive Protein and Carotid Intima-media Thickness in a Population of Middle-aged Koreans.: Mina Suh, Joo Young Lee, Song Vogue Ahn, Hyeon Chang Kim, Il Suh; J Prev Med Public Health. 2009;42(1):29-34.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.29

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Abstract PDF

OBJECTIVES
This study was performed to evaluate the relationship between C-reactive protein (CRP) and carotid intima-media thickness (carotid IMT) in a population of middle-aged Koreans. METHODS: A total of 1,054 men and 1,595 women (aged 40-70 years) from Kanghwa County, Korea, were chosen for the present study between 2006 and 2007. We measured high-sensitivity CRP and other major cardiovascular risk factors including anthropometrics, blood pressure, blood chemistry, and carotid ultrasonography. Health related questionnaires were also completed by each study participant. Carotid IMT value was determined by the maximal IMT at each common carotid artery. The relationship between CRP level and carotid IMT was assessed using multiple linear and logistic regression models after adjustment for age, body mass index, menopause (women), systolic blood pressure, total/HDL cholesterol ratio, triglyceride level, fasting glucose, smoking, and alcohol consumption. RESULTS: Mean carotid IMT values from the lowest to highest quartile of CRP were 0.828, 0.873, 0.898, and 0.926 mm for women (p for trend<0.001), and 0.929, 0.938, 0.949, and 0.979 mm for men (p for trend=0.032), respectively. After adjustment for major cardiovascular risk factors, the relationship between CRP and carotid IMT was significant in women (p for trend=0.017), but not in men (p for trend=0.798). Similarly, adjusted odds ratio of increased IMT, defined as the sex-specific top quartile, for the highest versus lowest CRP quartiles was 1.55 (95% CI=1.06-2.26) in women, but only 1.05 (95% CI=0.69-1.62) in men. CONCLUSIONS: CRP and carotid IMT levels appear to be directly related in women, but not in men.

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Giovanni Tarantino, Luigi Barrea, Domenico Capone, Vincenzo Citro, Teresa Mosca, Silvia Savastano
Frontiers in Endocrinology.2018;[Epub] CrossRef
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Ju-Mi Lee, Hyeon Chang Kim, Hye Min Cho, Sun Min Oh, Dong Phil Choi, Il Suh
Journal of Preventive Medicine and Public Health.2012; 45(3): 181. CrossRef
Relationships between high-sensitive C-reactive protein and markers of arterial stiffness in hypertensive patients. Differences by sex
Manuel A Gomez-Marcos, Jose I Recio-Rodríguez, Maria C Patino-Alonso, Cristina Agudo-Conde, Leticia Gomez-Sanchez, Emiliano Rodriguez-Sanchez, Marta Gomez-Sanchez, Vicente Martinez-Vizcaino, Luis Garcia-Ortiz
BMC Cardiovascular Disorders.2012;[Epub] CrossRef

Research Support, Non-U.S. Gov't

The Association Between Circulating Inflammatory Markers and Metabolic Syndrome in Korean Rural Adults.: So Yeon Ryu, Ki Soon Kim, Jong Park, Myeng Guen Kang, Mi Ah Han; J Prev Med Public Health. 2008;41(6):413-418.; DOI: https://doi.org/10.3961/jpmph.2008.41.6.413

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Abstract PDF

OBJECTIVES
This study was performed to investigate the associations between the metabolic syndrome (MetS) and inflammatory markers. METHODS: This cross-sectional analysis was performed using data from 1578 Koreans aged 40-69 years residing in a rural area. We investigated associations between MetS and circulating high sensitivity C-reactive protein (hs-CRP), white blood cells (WBC) and adiponectin. MetS was defined using the criteria proposed by the National Cholesterol Education Program Adult Treatment Panel III (ATP-III). RESULTS: Increased WBC counts and hs-CRP levels and decreased adiponectin levels were observed in subjects with MetS. WBC, hs-CRP and adiponectin levels linearly deteriorated with an increase in the number of MetS components (all ptrend <0.005). Finally, adjusted odds ratios (ORs) for the risk of MetS by increase/decrease in 3 inflammatory markers were calculated by multivariate logistic regression analyses. In terms of changes in inflammation markers, in men, the adjusted ORs (95% confidence interval) were 1.15 (1.01-1.31) for WBC, 1.64 (1.02-2.64) for hs-CRP, and 0.19 (0.08-0.45) for adiponectin, whereas corresponding adjusted ORs (95% CIs) in women were 1.27 (1.15-1.40), 0.98 (0.67-1.42), 0.09 (0.04-0.18), respectively. CONCLUSIONS: Serum adiponectin levels and WBC counts were found to be strongly associated with MetS in both sexes. However, hs-CRP lost its significance after adjusting for BMI and other inflammatory markers in women. This study shows that inflammatory response is associated with MetS in the Korean population. Further prospective studies are necessary to confirm the contribution made by inflammatory markers to the development of MetS.

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English Abstract

The Association of High Sensitivity C-reactive Protein (hsCRP) with Hypertension in Some Rural Residents.: Young Seon Lee, So Yeon Ryu, Jong Park, Myeong Guen Kang, Ki Soon Kim; J Prev Med Public Health. 2005;38(3):325-329.

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Abstract PDF: OBJECTIVE
This study was performed to assess the association between high sensitivity C-Reactive Protein (hsCRP) and hypertension. METHODS: We evaluated the relationship between hsCRP with hypertension and other cardiovascular risk factors, using a cross-sectional survey of 202 people over the age of 50, living in a rural area. A logistic regression analysis was used to study the association between hsCRP and hypertension. The hsCRP levels were divided in quartiles, and the odds ratios (OR), with 95% confidence intervals (95% CI), calculated, using the lowest quartile as a reference. RESULTS: The subjects consisted of 37.1% men and 62.9% women, with a mean (SD) hsCRP level of 1.9 (+/-3.0) mg/l. The overall prevalence of hypertension was 61.4%. The prevalence of hypertension according to the hsCRP quartile was not statistically significant. After adjustment for confounding variables, the prevalence of hypertension according to the subjects in the 2nd, 3rd and 4th hsCRP quartiles were 1.418 (95% CI=0.554-3.628), 1.124 (95% CI=0.392-3.214) and 0.892 (95% CI=0.312-2.547) times higher, respectively, compared to those in the 1st quartile. CONCLUSIONS: The results showed that the level of hsCRP was not a risk factor for hypertension among adults aged over 50 years, living in a rural area. A further study should be performed to find the association between hsCRP and hypertension.; Summary

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