Systemic inflammation is associated with incident stroke and heart disease in East Asians
Authors: Karim Mohd A. , Kartsonaki Christiana , Bennett Derrick A. , Millwood Iona Y. , Hill Michael R. , Avery Daniel , Bian Zheng , Du Huaidong , Guo Yu , Qian Yijian , Qu Chan , Turnbull Iain , Schmidt-Valle Dan , Wang Chunmei , Yu Canqing , Lv Jun , Chen Junshi , Clarke Robert , Li Liming , Chen Zhengming , Holmes Michael V. , Walters Robin G. ,   China Kadoorie Biobank Collaborative Group, Collins Rory , Liu Depei , Peto Richard , Boxall Ruth , Chang Yumei , Chen Yiping , Gilbert Simon , Hacker Alex , Iona Andri , Kerosi Rene , Kong Ling , Kurmi Om , Lancaster Garry , Lewington Sarah , Lin Kuang , McDonnell John , Nie Qunhua , Ryder Paul , Sansome Sam , Sherliker Paul , Sohoni Rajani , Stevens Becky , Wang Jenny , Wang Lin , Wright Neil , Yang Ling , Yang Xiaoming , Yao Pang , Han Xiao , Hou Can , Pei Pei , Liu Chao , Pang Zengchang , Gao Ruqin , Li Shanpeng , Wang Shaojie , Liu Yongmei , Du Ranran , Cheng Liang , Tian Xiaocao , Zhang Hua , Zhai Yaoming , Ning Feng , Sun Xiaohui , Li Feifei , Lv Silu , Wang Junzheng , Hou Wei , Zou Mingyuan , Yan Shichun , Zhou Xue , Yu Bo , Li Yanjie , Xu Qinai , Kang Quan , Guo Ziyan , Dan Wang  , Hu Ximin , Chen Jinyan , Fu Yan , Wang Xiaohuan , Weng Min , Guo Zhendong , Wu Shukuan , Li Yilei , Li Huimei , Wu Ming , Zhou Yonglin , Zhou Jinyi , Tao Ran , Yang Jie , Su Jian , liu Fang , Zhang Jun , Hu Yihe , Lu Yan , Ma Liangcai , Tang Aiyu , Hua Yujie , Jin Jianrong , Liu Jingchao , Tang Zhenzhu , Chen Naying , Huang Ying , Li Mingqiang , Meng Jinhuai , Pan Rong , Jiang Qilian , Lan Jian , Liu Yun , Wei Liuping , Zhou Liyuan , Chen Ningyu , Wang Ping , Meng Fanwen , Wang Yulu Qin Sisi , Wu Xianping , Zhang Ningmei , Chen Xiaofang , Zhou Weiwei , Luo Guojin , Li Jianguo , Chen Xiaofang , Zhong Xunfu , Liu Jiaqiu , Sun Qiang , Ge Pengfei , Ren Xiaolan , Dong Caixia , Zhang Hui , Mao Enke , Wang Xiaoping , Wang Tao , Zhang Xi , Zhou Ding Zhang , Zhou Gang , Feng Shixian , Chang Ling , Fan Lei , Gao Yulian , He Tianyou , Sun Huarong , He Pan , Hu Chen , Zhang Xukui , Wu Huifang , Yu Min , Hu Ruying , Wang Hao , Gong Weiwei , Wang Meng , Xie Kaixu , Chen Lingli , Pan Dongxia , Gu Qijun , Huang Yuelong , Chen Biyun , Yin Li , Liu Huilin , Fu Zhongxi , Xu Qiaohua , Xu Xin , Zhang Hao , Long Huajun , Zhang Libo 
Published: March 2020

Systemic inflammation, reflected by increased plasma concentrations of C-reactive protein (CRP) and fibrinogen, is associated with increased risk of coronary heart disease, but its relevance for stroke types remains unclear. Moreover, evidence is limited in non-European populations. We investigated associations of CRP and fibrinogen with risks of incident major coronary events (MCE), ischemic stroke (IS) and intracerebral hemorrhage (ICH) in a cohort of Chinese adults. A nested case-control study within the prospective China Kadoorie Biobank included 1,508 incident MCE cases, 5,418 IS cases, 4,476 ICH cases, and 5,285 common controls, aged 30–79 years. High-sensitivity CRP and low-density lipoprotein cholesterol (LDL-C) were measured in baseline plasma samples from all participants, and fibrinogen in a subset (n = 9,380). Logistic regression yielded adjusted odds ratios (ORs) per SD higher usual levels of log-transformed CRP and fibrinogen. The overall mean (SD) baseline LDL-C was 91.6 mg/dL (24.0) and geometric mean (95% CI) CRP and fibrinogen were 0.90 mg/L (0.87–0.93) and 3.01 g/L (2.98–3.03), respectively. There were approximately log-linear positive associations of CRP with each outcome, which persisted after adjustment for LDL-C and other risk factors, with adjusted ORs (95% CI) per SD higher CRP of 1.67 (1.44–1.94) for MCE and 1.22 (1.10–1.36) for both IS and ICH. No associations of fibrinogen with MCE, IS, or ICH were identified. Adding CRP to prediction models based on established risk factors improved model fit for each of MCE, IS, and ICH, with small improvements in C-statistic and correct reclassification of controls to lower risk groups. Among Chinese adults, who have low mean LDL-C, CRP, but not fibrinogen, was independently associated with increased risks of MCE and stroke.