C-reactive protein as a screening test for cardiovascular risk in a multiethnic population

Background-Small increases in the inflammatory marker C-reactive protein (CRP) are predictive of vascular events among asymptomatic individuals. There are few data supporting the use of CRP as a risk marker among nonwhite individuals. Methods and Results-1250 adults of South Asian, Chinese, European, and Aboriginal ancestry were randomly sampled from 4 communities in Canada. Participants provided fasting blood samples for CRP, glucose, lipids, and coagulation factors, and they had undergone a carotid B-mode ultrasound. Cardiovascular disease was determined by history and electrocardiogram. The age- and sex-adjusted mean CRP was 3.74 mg/L (standard error, 0.14) among Aboriginals, 2.59 mg/L (0.12) among South Asians, and 1.18 mg/L (0.13) among Chinese compared with 2.06 mg/L ( 0.12) among Europeans (overall P < 0.0001). Differences in the CRP concentration between ethnic groups were substantially diminished, but not abolished, after adjustment for metabolic factors. CRP was independently associated with CVD after adjusting for the Framingham risk factors, atherosclerosis, anthropometric measurements, and ethnicity (OR = 1.03 for a 0.1-increase in CRP; P = 0.02). Conclusions-CRP varies substantially between people of different ethnic origin and is influenced by their differences in metabolic factors. Prospective validation of CRP as a risk predictor for cardiovascular disease among nonwhite ethnic groups is required.