Heterogeneity of Serum Creatine Kinase Activity among Racial and Gender Groups of the Population

Et, Wong; Cobb, Camilla J.; Mk, Umehara; Ga, Wolff; Lj, Haywood; Greenberg, Tokoko T.; St, Shaw

doi:10.1093/ajcp/79.5.582

Cited by 104 publications

(40 citation statements)

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“…This is in agreement with the differences in mean and maximal values seen in other studies3 27 and is in line with the existence of sex-specific reference intervals for CK in the general population 17 22 – 26. These differences may be explained by the higher CK content of men’s muscle than that of women’s muscle,28 although other factors, such as muscle membrane permeability, CK clearance rate and lymph activity cannot be excluded.…”

Section: Discussionsupporting

confidence: 91%

“…It is noteworthy that the upper reference limits in the non-athletes of this study are among the highest in the literature. In particular, Wu,17 Wong et al ,22 and Schumann and Klauke23 have proposed limits that are under 350 U/L in males and under 200 U/L in females. Miller et al 24 and Strømme et al 25 have proposed limits (males, 391 and 398; females, 240 and 207 U/L, respectively) whose CI overlap with the CI of the limits in this study.…”

Section: Discussionmentioning

confidence: 99%

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Reference intervals for serum creatine kinase in athletes

Mougios¹

2007

Br J Sports Med

236

157

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Background: The serum concentration of creatine kinase (CK) is used widely as an index of skeletal muscle fibre damage in sport and exercise. Since athletes have higher CK values than non-athletes, comparing the values of athletes to the normal values established in non-athletes is pointless. The purpose of this study was to introduce reference intervals for CK in athletes. Method: CK was assayed in serum samples from 483 male athletes and 245 female athletes, aged 7-44. Samples had been obtained throughout the training and competition period. For comparison, CK was also assayed in a smaller number of non-athletes. Reference intervals (2.5th to 97.5th percentile) were calculated by the non-parametric method. Results: The reference intervals were 82-1083 U/L (37˚C) in male and 47-513 U/L in female athletes. The upper reference limits were twice the limits reported for moderately active non-athletes in the literature or calculated in the non-athletes in this study. The upper limits were up to six times higher than the limits reported for inactive individuals in the literature. When reference intervals were calculated specifically in male football (soccer) players and swimmers, a threefold difference in the upper reference limit was found (1492 vs 523 U/ L, respectively), probably resulting from the different training and competition demands of the two sports. Conclusion: Sport training and competition have profound effects on the reference intervals for serum CK. Introducing sport-specific reference intervals may help to avoid misinterpretation of high values and to optimise training.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Reference intervals for serum creatine kinase in athletes

Mougios¹

2007

Br J Sports Med

236

157

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“…Notably, the 95th percentiles for black men and women in this study (712 and 323 IU/L, respectively) are similar to 97.5th percentiles in smaller studies by Brewster (801 and 414 IU/L) and Wong (520 and 345 IU/L). [4,7] The specific values reported here may not be applicable to all assays but demonstrate the magnitude of differences between racial groups. Reference ranges should be validated in individual laboratories.…”

Section: Discussionmentioning

confidence: 87%

Creatine kinase in the U.S. population

2016

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Background:Creatine kinase (CK) values are a critical part of the workup of suspected myopathies and are often assessed in patients that develop myalgia on statin therapy. CK elevations may influence the initiation and cessation of statin treatment, and incidentally discovered CK elevation may lead to further testing. A number of factors influence CK levels in healthy patients, but current reference ranges do not incorporate important influencers of CK such as race. Objectives of this study were to evaluate clinical factors associated with CK among healthy individuals and to develop practical reference ranges for important subgroups to improve test interpretation.Methods:CK was evaluated in nonpregnant participants ≥20 years old from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2011–2014. Linear and logistic regression stratified by sex identified clinical factors associated with CK levels. Adjustment for anthropomorphic measures assessed whether age and race-ethnicity differences in CK were explained by differences in body composition. The 95th and 97.5th percentiles of CK in sex/race-ethnicity subgroups were calculated, excluding patients with recent strenuous exercise.Results:A total of 10,096 nonpregnant adults were studied. Black race was strongly associated with CK. The odds ratio of having an abnormal CK for black women was 5.08 (95% CI 3.65–7.08) and for black men was 8.39 (95% CI 6.11–11.52). CK was substantially lower in older men. Differences in CK by age but not race-ethnicity were largely explained by body composition. Women with low body mass index were less likely to have an elevated CK, and overweight or obese men had an almost 2-fold greater odds of having an elevated CK. The 97.5th percentile of CK was 382 (95% CI 295–469) in white men, 1001 (95% CI 718–1284) in black men, 295 (95% CI 216–374) in white women, and 487 (95% CI 310–664) in black women.Conclusion:CK is substantially higher in men and in black patients. Differences in body size and composition are also important but do not explain racial differences in CK. The 95th and 97.5th percentiles in sex and race-ethnicity subgroups provide a practical guide for clinicians interpreting CK values.

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“…Age- and gender-related differences in blood CK levels have been previously reported [19,33]. Sex hormones may partially explain the divergent CK relationships found in several clinical covariates between men and women.…”

Section: Discussionmentioning

confidence: 89%

Gender-differences in the associations between circulating creatine kinase, blood pressure, body mass and non-alcoholic fatty liver disease in asymptomatic asians

Yen¹,

Wang²,

Lee³

et al. 2017

PLoS ONE

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BackgroundCreatine kinase (CK) is a pivotal regulatory enzyme in energy metabolism linked to both blood pressure and cardio-metabolic components. However, data is lacking in a large population of asymptomatic Asians.Methods and resultsCardio-metabolic assessment including anthropometric measures and non-alcoholic fatty liver disease (NAFLD) were evaluated by abdominal echo in 4,562 consecutive subjects who underwent an annual health survey. Serum CK levels were related to blood pressure components [systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP)], anthropometric measures, and excessive adiposity in liver as indicated by NAFLD. Circulating CK levels ranged from 4 to 1842 IU/L (mean [SE]: 108.7 [1.1] IU/L) in the study population which consisted of 2522 males (mean age: 48.7 ± 11.2) and 2040 females (mean age: 49.4±11.5). In general, male subjects presented with higher circulating CK levels than females (mean ± SE: 127.3 ± 1.5 vs. 85.5 ± 1.3 IU/L, respectively, p < .001). Gender-differences in circulating CK levels were also observed with increasing age, which showed a more pronounced positive relationship with age in female subjects (gender interaction: p < .05). Furthermore, an elevated circulating CK level was independently associated with higher blood pressure, waist circumference and fat mass (FM), greater body mass index (BMI), increased lower estimated glomerular filtration rate (eGFR) and presence of NAFLD in multivariate analysis (all p < .05), with CK elevation more pronounced with greater BMI and FM in males compared with females (sex interaction: p < .05).ConclusionIn a large asymptomatic Asian population, circulating CK levels were increased with more advanced age, higher blood pressure, and greater body mass with gender differences. Our findings may be useful in interpreting elevated CK from subjects free of ongoing myocardial damage.

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Heterogeneity of Serum Creatine Kinase Activity among Racial and Gender Groups of the Population

Cited by 104 publications

References 0 publications

Reference intervals for serum creatine kinase in athletes

Reference intervals for serum creatine kinase in athletes

Creatine kinase in the U.S. population

Gender-differences in the associations between circulating creatine kinase, blood pressure, body mass and non-alcoholic fatty liver disease in asymptomatic asians

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