High‐sensitivity C‐reactive protein and risk of type 2 diabetes: A nationwide cohort study and updated meta‐analysis
Xue Yang, Siyuan Tao, Jieru Peng, Jian Zhao, Sheyu Li, Nianwei Wu, Ying Wen, Qingping Xue, Chunxia Yang, Xiong‐Fei Pan
Abstract
Abstract Objective To prospectively examine the association of high sensitivity C‐reactive protein (hs‐CRP) with incident type 2 diabetes mellitus (T2DM) among middle‐aged and elderly Chinese, and validate the association in an updated meta‐analysis of prospective studies. Methods We used data from the China Health and Retirement Longitudinal Study, started in 2011–2012 with follow ups in 2013–2014 and 2015–2016. Multivariable Cox proportional hazard regressions were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between hs‐CRP level and incident T2DM. An updated meta‐analysis was conducted to combine our estimates with those in previous prospective studies. Results Included in the analyses were 7985 participants (mean age: 59.38 years; men: 46.73%). Higher hs‐CRP was associated with increased risk of T2DM (multivariable‐adjusted HR, 1.30; 95% CI: 1.03, 1.64 for comparing extreme quartiles). The association was stronger in participants with body mass index (BMI) of 24.0 kg/m 2 or higher than those with a BMI lower than 24.0 kg/m 2 ( p for interaction = 0.038). In a meta‐analysis of 28 cohorts, 2 case‐cohort, and 6 nested case‐control studies among 125,356 participants with 10,759 cases, the pooled relative risk for T2DM was 1.77 (95% CI: 1.60, 1.96) for the highest versus lowest level of hs‐CRP. Conclusions Hs‐CRP was associated with higher risk of T2DM in middle‐aged and elderly Chinese, and this association was confirmed by an updated meta‐analysis of prospective studies. Our findings highlight the role of elevated hs‐CRP in the development of T2DM.