There is strong evidence from observational studies suggesting serum C-reactive protein (CRP) is associated with cardiovascular and all-cause mortality. However, less is known about whether there are differences in the association of CRP with all-cause or cause specific mortality by sex, smoking, body mass index (BMI), or physical activity. We aimed to investigate these interactions and also investigate and compare the association of CRP and other inflammation markers (i.e., fibrinogen and leukocyte count) with all-cause and cause-specific mortality. Men and women aged 40-79 were recruited in 1993-1997 in the EPIC-Norfolk cohort study. A total of 16,850 participants with high-sensitivity assayed CRP data who had no known cancer, myocardial infarction and stroke at baseline were entered in the analysis to test the association of CRP, fibrinogen and leukocyte count with risk of all-cause and cause specific mortality. A total of, 2,603 all-cause deaths (1,452 in men) including 823 cardiovascular and 1,035 cancer deaths, were observed after 231,000 person-years of follow-up (median 14.3 years). CRP was positively associated with risk of all-cause, cardiovascular, and non-cancer non-cardiovascular mortality independent of established risk factors. The hazard ratio of all-cause mortality (95 % CI) for participants with CRP in the range of 3-10 and >10 mg/l (vs. <0.5 mg/l) was 1.56 (1.26-1.93) and 1.87 (1.43-2.43) respectively in men and 1.34 (1.07-1.68) and 1.98 (1.50-2.63) in women. The association was less positively graded in women with the increased risk being significant only at higher levels of the CRP distribution. The association persisted in never smokers and did not vary by levels of BMI or physical activity. Although fibrinogen and leukocyte count were also positively associated with mortality risk, only CRP remained a significant predictor of mortality when the inflammation markers were adjusted for one another in multivariable models. Serum CRP levels were a long-term predictor of risk of cardiovascular and non-cardiovascular mortality independent of known risk factors, fibrinogen, and leukocyte count.

中文翻译：

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与男性和女性 C 反应蛋白、纤维蛋白原和白细胞计数相关的 17 年全因和特定原因死亡风险：EPIC-Norfolk 研究。

观察性研究有强有力的证据表明血清 C 反应蛋白 (CRP) 与心血管和全因死亡率相关。然而，关于 CRP 与全因死亡率或因性别、吸烟、体重指数 (BMI) 或体力活动导致的特定死亡率之间的关联是否存在差异，我们知之甚少。我们旨在调查这些相互作用，并调查和比较 CRP 和其他炎症标志物（即纤维蛋白原和白细胞计数）与全因和特定原因死亡率的关系。1993-1997 年，EPIC-诺福克队列研究招募了 40-79 岁的男性和女性。共有 16,850 名具有高灵敏度测定 CRP 数据且基线时没有已知癌症、心肌梗塞和中风的参与者被纳入分析，以测试 CRP、纤维蛋白原和白细胞计数具有全因风险和特定死亡率。在 231,000 人年（中位 14.3 年）的随访后，共观察到 2,603 例全因死亡（男性 1,452 例），包括 823 例心血管死亡和 1,035 例癌症死亡。CRP 与全因、心血管和非癌症非心血管死亡的风险呈正相关，与既定风险因素无关。CRP 在 3-10 和 >10 mg/l（对比 <0.5 mg/l）的参与者的全因死亡率风险比 (95% CI) 分别为 1.56 (1.26-1.93) 和 1.87 (1.43)男性分别为 -2.43) 和女性 1.34 (1.07-1.68) 和 1.98 (1.50-2.63)。该关联在女性中的积极评分较低，仅在较高水平的 CRP 分布中风险增加才显着。这种关联在从不吸烟者中持续存在，并且不因 BMI 或身体活动水平而异。尽管纤维蛋白原和白细胞计数也与死亡风险呈正相关，但当在多变量模型中相互调整炎症标志物时，只有 CRP 仍然是死亡率的重要预测因子。血清 CRP 水平是心血管和非心血管死亡风险的长期预测因子，与已知的风险因素、纤维蛋白原和白细胞计数无关。