C-reactive protein (CRP) and high-density lipoprotein (HDL) cholesterol are well-known cardiovascular predictors. However,the joint effect of these parameters on long-term mortality has not been established.
We studied a total of 92,500 subjects older than 20 years who underwent routine health examination at the three health care centers affiliated with Seoul National University. High-sensitivity CRP and the lipid profile were obtained at baseline. Subjects were followed for a median of 45.5 months. Mortality data were obtained from the National Statistics Office of Korea.
There were 649 deaths (0.7%) during the follow-up. The leading cause of death was cancer. The subjects who died were significantly older,had a male predominance,and had increased levels of inflammatory markers. A significant mortality difference was identified according to the CRP and HDL cholesterol levels. Considering both parameters jointly,subjects with a CRP ≥1.4 mg/L (highest quartile) and HDL cholesterol <45 mg/dL (lowest quartile) were at the highest risk for all-cause mortality,even after adjusting for covariates (hazard ratio 2.29,95% confidence interval,1.83∼2.87). After matching on the propensity score,6304 subjects with a high CRP and low HDL cholesterol were at high risk of death (hazard ratio 2.52,95% confidence interval,1.59∼4.01). Interestingly,the joint effect of CRP and HDL cholesterol was observed for cardiovascular as well as cancer-related mortality prediction.
Elevated CRP and low HDL cholesterol jointly contribute to the prediction of all-cause,cancer,and cardiovascular mortality in Koreans. The interactive relationship between them in mediating inflammatory processes might explain these results.