BackgroundOne measurement of hs‐CRP (high‐sensitivity C‐reactive protein) is associated with increased risk of cardiovascular disease (CVD). The objective of this study was to characterize the association of cumulative exposure to increased hs‐CRP with incident cardiovascular events.Methods and ResultsWe included 53 065 participants with hs‐CRP measured at 3 examinations in 2006, 2008, and 2010. Cumulative exposure to hs‐CRP was calculated as the weighted sum of the average hs‐CRP level for each time interval (level×time). Participants were classified into nonexposed group (hs‐CRP<3.0 mg/L in all 3 examinations), 1‐exposed group (hs‐CRP≥3.0 mg/L in 1 of the 3 examinations), 2‐exposed group (hs‐CRP≥3.0 mg/L in 2 of the 3 examinations), and 3‐exposed group (hs‐CRP≥3.0 mg/L in 3 examinations). Cox proportional hazards models were used to assess the association of cumulative hs‐CRP with incident CVD. The study showed a dose‐response pattern with risk of CVD and myocardial infarction as the number of years of exposure to hs‐CRP increases. Participants in the 3‐exposed group had significantly increased CVD risk with hazard ratio (95% confidence interval) of 1.38 (1.11–1.72), in comparison with 1.28 (1.07–1.52) for participants in the 2‐exposed group and 1.13 (0.97–1.31) for those in the 1‐exposed group (P<0.05); meanwhile, the similar and significant associations were also observed for myocardial infarction with respective hazard ratio (95% confidence interval) of 2.13 (1.42–3.18), 1.60 (1.12–2.27), and 1.57 (1.17–2.10). The associations between stroke and cumulative hs‐CRP were not statistically significant (P=0.360).ConclusionsCumulative exposure to hs‐CRP was dose dependently associated with a subsequent increased risk of CVD and myocardial infarction.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: ChiCTR‐TNC‐11001489.

BACKGROUND: Data are lacking regarding cardiovascular health (CVH) with Life’s Essential 8 approach and future stroke risk. We sought to elucidate whether the CVH score constructed by the Life’s Essential 8 metrics predicted stroke risk in 2 Chinese ongoing cohorts. METHODS: This included 41 043 participants of the Kailuan I study and 27 842 participants of the Kailuan II study who were free of cardiovascular disease or cancer in 2014. CVH score (ranged from 0 to 100) was assessed using the Life’s Essential 8 metrics (body mass index, cigarette smoking, diet quality, physical activity, sleep health, lipid, blood glucose, and blood pressure). A composite of incident stroke events (ischemic stroke and hemorrhagic stroke) was identified via review of medical records. The follow-up period was calculated from the finishing date of the 2014 survey to either the date of stroke occurrence, death, loss to follow-up, or the end of follow-up (December 31, 2020). We also examined the longitudinal association between the CVH score and arterial stiffness status, as assessed by brachial-ankle pulse wave velocity, in 25 922 participants free of cardiovascular disease during the follow-up. We performed a meta-analysis to assess the association between CVH, based on the 2010 American Heart Association recommendation, and stroke integrating the results of current study and previous studies. RESULTS: During a median follow-up of 5.65 years (interquartile range, 5.20–6.09), a total of 1750 incident stroke events were identified in the pooled Kailuan study. The pooled hazard ratios were 0.33 (95% CI, 0.20–0.54) for ideal versus poor health category of CVH ( P trend <0.0001). Higher CVH scores were also associated with lower brachial-ankle pulse wave velocity values at baseline and slower increments of brachial-ankle pulse wave velocity during follow-up ( P trend ≤0.001 for both). Arterial stiffness mediated 9.07% (95% CI, 5.83%–15.0%) of the total association between CVH and incident stroke. The pooled hazard ratio comparing 2 extreme CVH categories for stroke was 0.45 (95% CI, 0.35–0.59) when including 10 published studies and the current study. CONCLUSIONS: The CVH score as assessed by the Life’s Essential 8 metrics significantly predicted future stroke risk and arterial stiffness status.

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Background and Objectives: This study was to characterize the association of cumulative exposure to increased high-sensitivity C-reactive protein (hs-CRP) with chronic kidney diseases (CKD). Methods: We included 35,194 participants with hs-CRP measured at three examinations in 2006, 2008, 2010. Participants were classified into nonexposed group (hs-CRP <3.0 mg/L in all 3 examinations), 1-exposed group (hs-CRP ≥3.0 mg/L in 1 of the 3 examinations), 2-exposed group (hs-CRP ≥3.0 mg/L in 2 of the 3 examinations), and 3-exposed group (hs-CRP ≥3.0 mg/L in 3 examinations). Cox proportional hazards models were used to assess the association of cumulative hs-CRP with incident CKD. CKD includes an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or urinary protein positive. Results: The study showed the risk of CKD as the number of years of exposure to hs-CRP increases. Participants in 3-exposed group had significantly increased CKD risk with hazard ratio (HR) (95% confidence interval, CI) of 1.70 (1.49–1.93), in comparison with 1.47 (1.34–1.62) for participants in the 2-exposed group, and 1.08 (1.00–1.16) for those in the 1-exposed group (p < 0.01); meanwhile, the similar and significant associations were also observed for eGFR <60 mL/min/1.73 m2, proteinuria positive, in participants of the 3-exposed group in comparison with the nonexposed group, with respective HRs (95% CI) of 1.27 (1.01–1.58) and 2.27 (1.87–2.76). Conclusions: Cumulative exposure to hs-CRP was associated with a subsequent increased risk of CKD and was of great value to risk prediction.