Metabolic Syndrome, High-sensitivity C-reactive Protein and the Risk of Heart Failure: The Kailuan Cohort Study

Yan Tian ¹ Yan xiu Wang ² Dan dan Zhao ¹ Hua yu Sun ¹ Hao Wu ¹ Peng Yang ³ Shou ling Wu ² Ying Wu ^1* Shuo hua Chen ^2* yun Li ^1,4,5*

• ¹ School of Public Health, North China University of Science and Technology, Tangshan, China
• ² Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei Province, China
• ³ Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei Province, China
• ⁴ Tangshan Key Laboratory of Clinical Epidemiol, tangshan, China
• ⁵ Hebei Key Laboratory of Occupational Health and Safety for Coal Industry, Tangshan, Hebei Province, China

Metabolic syndrome (MetS) and elevated high-sensitivity C-reactive protein (hs-CRP) have been identified as risk factors for heart failure (HF) in some studies. However, little was known about the co-exposure of MetS and inflammation to HF. We aimed to investigate the combined effect of MetS and high hs-CRP levels on the risk of incident HF.The study included 94,841 participants without HF selected from the Kailuan cohort in 2006 (the baseline) and then followed up until 31 December 2020. Participants were divided into four groups based on the presence of MetS and high hs-CRP levels (>3mg/L) at baseline: MetS-CRP-(n=53,937), MetS-CRP+ (n=10,338), MetS+CRP-(n=23,521), MetS+CRP+ (n=7,045). Cox regression models were used to analyze the association of MetS and inflammation with the risk of HF. Statistical significance was defined as a two-tailed P value < 0.05.The mean age of the participants was 51.5±12.5 years, and 75,976 (80.0%) were male. During 13.1 years of follow-up, 3,058 participants were diagnosed with HF. The HF incidence rate of four groups were 1.69/1000pys, 2.95/1000pys, 3.27/1000pys, 5.33/1000pys. The HR for MetS-CRP+, MetS+CRP-, and MetS+CRP+ were 1.29 (95% CI, 1.15-1.45), 1.40 (95% CI, 1.29-1.53), and 1.85 (95% CI, 1.65-2.06), respectively, compared with MetS-CRP-. After stratification by age (p for interaction < 0.01), compared with the MetS-CRP-group, the HR of the MetS+CRP+ group was 2.17 (95% CI, 1.83-2.57) in participants with < 60 years and 1.53 (95% CI, 1.32-1.78) in participants with ≥ 60 years. There was an interaction between groups and ues of antihypertension medication (p for interaction <0.01). Compared with MetS-CRP-, the risk of HF in the MetS+CRP+ group was increased 1.38-fold (95% CI, 1.12-1.70) in participants with antihypertension medication use and 2.00-fold (95% CI, 1.75-2.27) in participants without antihypertension medication use.The combination of MetS and elevated hs-CRP was associated with increased risk of HF in the Chinese population.