July 2, 2005Journal of the American College of Cardiology
Race and Gender Differences in C-Reactive Protein Levels
Why the study?
Few data are available comparing CRP distributions across different race and gender groups, despite clinical practice recommendations suggesting a uniform threshold to define high cardiovascular risk.
Study Design
Type
Cross-Sectional (n=2,749)
Structured PICO
P
Population
2,749 white and black adults ages 30 to 65 from a population-based probability sample assessed for race and gender differences in C-reactive protein levels.
O
Outcome
C-reactive protein (CRP) levels and proportion of subjects with CRP >3 mg/lsurrogate
Main Result
Odds Ratio: 1.7 (95% CI 1.2–2.6)
Absolute Event Rate: 58% vs 31%
p-value: p=<0.05
Significant race and gender differences exist in CRP levels, with women and black subjects having higher levels, which challenges the use of a uniform threshold for cardiovascular risk assessment.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We found that a greater percentage of women had CRP levels above 3 mg/L, yet women have a lower risk of cardiovascular events. This implies that perhaps the cut-offs that we use in CRP to indicate different risk levels may have to be adjusted for different race and gender groups.”
“This is a large study that highlights potentially important race and gender differences in CRP levels. The most striking finding was the observation that almost two-thirds of black women had CRP levels above the Centers for Disease Control-defined high-risk threshold. These differences may have implications for the broad use of CRP testing.”
“Our study was a snapshot of a population, but it showed that white women have higher levels of CRP than both black and white men. Since white women have lower rates of cardiovascular disease, this study raises some questions about how best to use CRP in the real-world setting. We need more research to determine if these differences translate into differences in cardiovascular events.”
Implication
Race/gender CRP disparities may influence CV risk interpretation; leaves open causal mechanisms and clinical utility.
Abstract
OBJECTIVES: This study sought to determine whether there are race and gender differences in the distribution of C-reactive protein (CRP) levels. BACKGROUND: Few data are available comparing CRP distributions in different race and gender groups. Recent clinical practice recommendations for CRP testing for cardiovascular risk assessment suggest a uniform threshold to define high relative risk (>3 mg/l). METHODS: We measured CRP in 2,749 white and black subjects ages 30 to 65 participating in the Dallas Heart Study, a multiethnic, population-based, probability sample, and compared levels of CRP between different race and gender groups. RESULTS: Black subjects had higher CRP levels than white subjects (median, 3.0 vs. 2.3 mg/l; p < 0.001) and women had higher CRP levels than men (median, 3.3 vs. 1.8 mg/l; p < 0.001). The sample-weight adjusted proportion of subjects with CRP levels >3 mg/l was 31%, 40%, 51%, and 58% in white men, black men, white women, and black women, respectively (p < 0.05 for each group vs. white men). After adjustment for traditional cardiovascular risk factors, estrogen and statin use, and body mass index, a CRP level >3 mg/l remained more common in white women (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.1 to 2.5) and black women (OR 1.7; 95% CI 1.2 to 2.6) but not in black men (OR, 1.3; 95% CI, 0.8 to 1.9) when compared with white men. CONCLUSIONS: Significant race and gender differences exist in the population distribution of CRP. Further research is needed to determine whether race and gender differences in CRP levels contribute to differences in cardiovascular outcomes, and whether thresholds for cardiovascular risk assessment should be adjusted for different race and gender groups.
Discussion
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Cite This Study
Khera et al. (2005) conducted a cross-sectional in Cardiovascular risk assessment (n=2,749). Black race and female gender vs. White men was evaluated on CRP level >3 mg/l (OR 1.7, 95% CI 1.2-2.6, p=<0.05).