High‐Sensitivity C‐Reactive Protein Levels Among Healthy Egyptian Elderly

C-reactive protein (CRP), a marker of systemic inflammation, is independently associated with risk of stroke, future acute coronary syndromes, and peripheral vascular disease.1 The American Heart Association (AHA) and the Centers for Disease Control and Prevention (CDC) have evaluated CRP as a risk assessment tool and suggested that categories of less than 1 mg/L, 1 to 3 mg/L, and more than 3 mg/L be used to identify those at lower, average, and high relative risk, respectively, of cardiovascular disease (CVD) events.2 Previous studies have shown that CRP levels vary substantially, between ethnic groups for example; the association between ethnicity and inflammation has been analyzed, and it has been found that black people often have higher CRP levels than whites.3-5 Chinese and Japanese also have lower CRP levels than Europeans and Americans.4 The aim of this study was to determine whether CRP levels in healthy Egyptian elderly adults varied from the set norm. A cross-sectional study was performed with 165 men and women aged 60 and older selected from the geriatrics outpatient clinic at Ain Shams University Hospital, Cairo, Egypt. Informed consent was obtained from all participants. Assessment included medical history, examination, and selected investigations. Participants with systemic disease or taking medications known to affect inflammatory markers were excluded. All participants underwent a medical history and physical examination. The weight and height of each participant was measured with the participant wearing in light clothes, and body mass index (BMI) was calculated as body weight in kilograms divided by meters squared. A venous blood sample from the antecubital vein was collected after an overnight fast of 12 hours from every participant and centrifuged within 30 minutes. Serum samples were stored in the central laboratory of Ain Shams University Hospital at −70°C until the time of assay. High-sensitivity C-reactive protein (hs-CRP) was measured using the enzyme-linked immunosorbent assay method (EuroGen Diagnostic Kit; DiaMed, Tessenderlo, Belgium). The upper limit of normal hs-CRP was considered to be 10 mg/L.2 Serum triglycerides, total cholesterol, and high-density lipoprotein cholesterol (HDL-C), were measured, and low-density lipoprotein cholesterol (LDL-C) was calculated in the central laboratory of Ain Shams University Hospital. Statistical analysis was performed using SPSS version 16 (IBM Corp., Somers, NY). Description of all data is in the form of means and standard deviations (SD) for quantitative variables and frequency and percentage for qualitative variables. Qualitative variables were compared using the chi-square test, and quantitative variables were compared using the t-test to compare two groups. Correlation coefficients were also determined to find linear relationships between variables using the r-test or Spearman correlation coefficients. P < .05 was considered to be significant and P < .01 highly significant. The mean age of the participants was 65.1 ± 6.9, 75 (45.5%) were male and 90 (54.5%) female. Table 1 shows the clinical and laboratory characteristics of the participants. There were no significant differences between men and women in terms of the studied variables. Hs-CRP was positively correlated to serum triglycerides (r = 0.186, P = .02), LDL-C (r = 0.201, P = .01), BMI (r = 0.341, P < .001), and age (r = 0.180, P = .02), and negatively correlated with HDL-C (r = −0.154, P = .049). These results demonstrate that, in elderly Egyptian men and women, CRP concentrations were higher than the accepted range of the AHA and the CDC in spite of the strict exclusion criteria for the factors that increase inflammation. As expected, it was also found that CRP level was associated with cardiovascular risk factors. Previous case and control studies done in elderly Egyptian adults also found high CRP levels in the control group.6, 7 Racial and ethnic differences in CRP have been studied before. For example, in a U.S. study examining ethnic differences in CRP concentrations, median CRP values varied significantly in all nonwhite groups from those of whites. CRP levels were highest in African-American participants (3.2 mg/L), followed by Hispanic (2.3 mg/L), white (1.5 mg/L), Chinese (0.7 mg/L), and Japanese (0.5 mg/L) participants.4 In a Canadian study, CRP concentrations were highest in men and women of aboriginal ancestry, followed by those of South Asian, European, and Chinese ancestry. In another study done in Holland, it was found that mean CRP levels were higher in Turkish migrants and Moroccan women than in the Dutch.8 These ethnic differences in inflammation may be due to socioeconomic status, health behavior factors, physical activity, diet, alcohol consumption, and cigarette smoking in addition to genetic factors, so future studies should investigate these factors that may influence the relation between race and ethnicity and inflammation as measured according to CRP. It should be questioned whether these high CRP levels in elderly Egyptian adults may be associated with greater Framingham risk score. Future epidemiological study is needed to determine whether elderly Egyptian adults have higher CRP norms. Conflict of Interest: None of the authors have any financial or other relationships that could lead to a conflict of interest. Author Contributions: Amer: Study concept and design, acquisition of subjects and data, interpretation of data, and preparation of the manuscript. Khater: Study design, acquisition of subjects and data, interpretation of data, and preparation of the manuscript. Mabrouk: Interpretation of data and preparation of the manuscript. Taha: Acquisition of subjects and data. Mohammedin: Study concept, acquisition of subjects and data, interpretation of data, and preparation of the manuscript. Sponsor's Role: None.

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