C-reactive protein to albumin ratio and risk of incident metabolic syndrome in community-dwelling adults: longitudinal findings over a 12-year follow-up period

Aim The CRP-to-albumin (CRP/Alb) ratio has emerged as a novel biomarker for various inflammatory diseases. This study aimed to evaluate the association between the CRP/Alb ratio and incident metabolic syndrome (MetS) with a large-sample, community-based Korean cohort over a 12-year follow-up period. Materials and Methods Among 10,030 participants, a total of 6,205 participants aged 40 to 69 years without MetS were selected from the Korean Genome and Epidemiology Study (KoGES). The baseline CRP/Alb ratio was divided into quartiles. Our definition of newly developed MetS was the one proposed by the 2009 Joint Interim Statement of Circulation. Hazard ratios (HRs) with 95% confidence intervals (CIs) for incident MetS were calculated using multivariate Cox proportional hazards regression models after adjusting for potentially confounding variables. Results During the 12-year follow-up period, MetS developed in 2,535 subjects (40.9%, 2,535/6,205) with an incidence rate of 5.6–11.9 (over 2 years). Compared to the reference first quartiles, the HRs (95% CIs) of incident MetS in the second, third, and fourth quartiles increased in a dose-response manner. Compared to the reference quartile, the HRs (95% CIs) for the incidence of MetS for the highest quartiles of CRP/Alb ratio was 1.47 (1.31–1.65) when considering age, sex, smoking status, alcohol intake, physical activity, TG level, HDL-C, mean arterial pressure, and HOMA-IR in the multivariate analysis. Conclusions High CAR at baseline may be a useful surrogate indicator of future incident MetS.