High-sensitivity C-reactive protein and cardiovascular events in a multi-ethnic cohort: the HELIUS study

AIM: Elevated high-sensitivity C-reactive protein (hsCRP) concentrations are associated with an increased atherosclerotic cardiovascular risk, but this has not been extensively investigated in multi-ethnic populations, including South Asians, who are characterized by an increased cardiometabolic risk.

METHODS: In this general population study we included 14,663 participants from the HEalthy Life In an Urban Setting (HELIUS) study (Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin). Mortality and cardiovascular event data were collected from nationwide registries. Differences in hsCRP levels and the association between hsCRP and cardiovascular events across the ethnic groups were assessed.

RESULTS: The mean age was 44±13 years, 55% were female. Median hsCRP at baseline was 1.0 (0.5-2.1) mg/L in the European, 1.3 (0.6-2.7) mg/L in the African, and 1.6 (0.7-3.3) mg/L in the South Asian participants (p <0.001). A total number of 568 cardiovascular events were recorded over a median follow-up time of 8.8 (7.8-9.7) years. hsCRP was associated with cardiovascular events in the European and African participants (adjusted HR per 1 mg/L increase in hsCRP: 1.08 [95% CI 1.00-1.16]; and 1.09 [95% CI 1.03-1.16], respectively), but not in the South Asian participants, despite having the highest event rate.

CONCLUSIONS: hsCRP was associated with incident cardiovascular events in individuals of European and African descent but not in South Asian individuals, despite higher hsCRP values. These findings suggest the need to find alternative inflammatory biomarkers to allow for a more reliable assessment of the increased cardiometabolic risk in South Asian individuals.