***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We conducted a prospect i ve , nested , case-control study of inflammatory markers as predictors of  type 2 diabetes among 32,826 women who provided blood sample s in 1989 through 1990 in the Nurses ' Health Study . Among women free of diabetes , cardiovascular disease , or cancer at baseline , 737 had developed diabetes by 2000 . Control women ( n = 785 ) were selected matched on age , fasting status , race , and BMI for cases in the top BMI decile . Baseline levels of tumor necrosis factor (TNF)-alpha receptor 2 , interleukin (IL)-6 , and C-reactive protein ( CRP ) were significantly higher among case than control subjects ( all P < /= 0.001 ) . After adjusting for BMI and other lifestyle factors , all three biomarkers significantly predicted diabetes risk ; the odds ratios ( ORs ) comparing extreme quintiles were 1.64 ( 95 % CI 1.10 - 2.45 ) for TNF-alphaR2 , 1.91 ( 1.27 - 2.86 ) for IL-6 , and 4.36 ( 2.80 - 6.80 ) for CRP ( P for trend < 0.001 for all biomarkers ) . In a multivariate model simultaneously including the three biomarkers , only CRP levels were significantly associated with risk of diabetes ( OR comparing extreme quintiles of CRP = 3.99 , P for trend < 0.001 ) . These data support the role of inflammation in the pathogenesis of type 2 diabetes . Elevated CRP levels are a strong independent predictor of type 2 diabetes and may mediate associations of TNF-alphaR2 and IL-6 with type 2 diabetes Background —Indian Asians in the United Kingdom have increased coronary heart disease ( CHD ) mortality compared with European whites , but the causes are not well understood . Increased circulating concentrations of C-reactive protein ( CRP ) are an independent risk factor for CHD . Therefore , we investigated this marker of inflammation in healthy UK Indian Asian and European white men . Methods and Results —We measured  serum CRP concentrations and conventional CHD risk factors in 1025 healthy male subjects ( 518 Indian Asians and 507 European whites ) aged 35 to 60 years who were recruited at r and om from general practitioner lists . The geometric mean CRP concentration was 17 % higher ( 95 % confidence interval , 3 % to 33 % ) in Indian Asians compared with European whites . CRP values were strongly associated with conventional CHD risk factors , measures of obesity , and metabolic disturbances associated with insulin resistance in both racial groups . The difference in CRP concentrations between Indian Asians and European whites remained after adjustment for conventional CHD risk factors but was eliminated by an adjustment for central obesity and insulin resistance score in Asians . On the basis of these results , we estimate that the processes underlying elevated CRP and /or increased CRP production itself are associated with an ≈14 % increase in population CHD risk among Indian Asians compared with European whites . Conclusions —CRP concentrations are higher in healthy Indian Asians than in European whites and are accounted for by greater central obesity and insulin resistance in Indian Asians . Our results suggest that inflammation or other mechanisms underlying elevated CRP values may contribute to the increased CHD risk among Indian Asians Background —C-reactive protein ( CRP ) has repeatedly been associated with blood pressure and prevalent and incident hypertension , but whether a causal link exists is uncertain . Methods and Results —We assessed the cross-sectional relations of CRP to systolic blood pressure , pulse pressure , and prevalent hypertension in a representative sample of > 3500 British women aged 60 to 79 years . For both outcomes , substantial associations were observed . However , these associations were greatly attenuated by adjustment for a wide range of confounding factors acting over the life course . We further investigated causality using a Mendelian r and omization approach by examining the association of the 1059G/C polymorphism in the human CRP gene with  CRP  and with blood pressure , pulse pressure , and hypertension . The polymorphism was associated with a robust difference in CRP , and the expectation would be for higher blood pressure and pulse pressure and greater prevalence of hypertension among those carrying the genetic variant associated with higher CRP levels . This was not observed , and the predicted causal effects of CRP on blood pressure , pulse pressure , and hypertension using instrumental variables methods were close to 0 , although with wide CIs . Conclusions —CRP levels are associated with blood pressure , pulse pressure , and hypertension , but adjustment for life course confounding and a Mendelian r and omization approach suggest the elevated CRP levels do not lead to elevated blood pressure BACKGROUND C-reactive protein ( CRP ) predicts risk of myocardial infa rct ion ( MI ) and stroke among apparently healthy men , but in women , virtually no data are available . METHODS AND RESULTS  CRP  was measured in baseline blood sample s from 122 apparently healthy participants in the Women 's Health Study who subsequently suffered a first cardiovascular event and from 244 age- and smoking-matched control subjects who remained free of cardiovascular disease during a 3-year follow-up period . Women who developed cardiovascular events had higher baseline CRP levels than control subjects ( P=0.0001 ) , such that those with the highest levels at baseline had a 5-fold increase in risk of any vascular event ( RR=4.8 ; 95 % CI , 2.3 to 10.1 ; P=0.0001 ) and a 7-fold increase in risk of MI or stroke ( RR=7.3 ; 95 % CI , 2.7 to 19.9 ; P=0.0001 ) . Risk estimates were independent of other risk factors , and prediction models that included CRP provided a better method to predict risk than models that excluded CRP ( all P values < 0.01 ) . In stratified analyses , CRP was a predictor among subgroups of women with low as well as high risk as defined by other cardiovascular risk factors . CONCLUSIONS In these prospect i ve data among women , CRP is a strong independent risk factor for cardiovascular disease that adds to the predictive value of risk models based on usual factors alone . ( Circulation . 1998;98:731 - 733 . BACKGROUND There is much interest in reported associations between serum C-reactive protein and incident ischaemic heart disease .  It is uncertain what this association represents . We aim ed to assess the effect of confounding from a number of different sources in the Caerphilly Prospect i ve Heart Disease Study and in particular whether the low grade inflammation indicated by C-reactive protein may be the mechanism whereby non-circulating risk factors may influence pathogenesis of ischaemic heart disease . METHODS  Plasma specimens collected during 1979 - 83 from 1395 men with sufficient sample remaining were assayed for serum C-reactive protein by ELISA .  Subsequent mortality and incident ischaemic heart disease events were ascertained from death certificates , hospital records and electrocardiographic changes at 5-yearly follow-up examinations . RESULTS There was a positive association between C-reactive protein and incident ischaemic heart disease ( P<0.005 ) mainly with fatal disease ( P<0.002 ) . There was also a positive association with all-cause mortality ( P<0.0001 ) . C-reactive protein was significantly associated with a number of non-circulating risk factors including body mass index ( P<0.0001 ) , smoking ( P<0.0001 ) , low forced expiratory volume in 1 s ( P<0.0001 ) , height ( P=0.025 ) , low childhood social class ( P=0.014 ) and age ( P=0.036 ) . C-reactive protein was also associated positively with circulating risk factors including viscosity , leukocyte count , fibrinogen ( all P<0.0001 ) and insulin ( P=0.0058 ) . After adjustment for non-circulating risk factors the association with all-incident ischaemic heart disease and ischaemic heart disease death became non-significant , but the association with all-cause mortality remained ( P=0.033 ) . Further adjustment for fibrinogen however removed any hint of an increasing trend in odds for all three outcomes . CONCLUSION C-reactive protein levels are raised in association with a variety of established cardiovascular risk factors . Neither C-reactive protein nor the systemic inflammation it represents appears to play a direct role in the development of ischaemic heart disease Background —Accumulating data suggest a link between blood pressure and vascular inflammation . Methods and Results —We examined the relationship between blood pressure , C-reactive protein ( CRP )  , and incident first cardiovascular events among 15 215 women followed prospect ively over a median of 8.1 years . In cross-sectional analyses at baseline , median levels of  CRP for women with blood pressure < 120/75 , 120 to 129/75 to 84 , 130 to 139/85 to 89 , 140 to 159/90 to 94 , and ≥160/95 mm Hg were 0.96 , 1.42 , 2.20 , 2.82 , and 3.34 mg/L , respectively ( P for trend < 0.0001 ) . Increasing categories of blood pressure were significant predictors of CRP levels at baseline . In prospect i ve analyses , both elevated CRP levels ( ≥3 mg/L ) and increasing categories of blood pressure were independent determinants of future cardiovascular events , and CRP had incremental prognostic value at all levels of blood pressure . The adjusted hazard ratio for women with blood pressure ≥160/95 mm Hg and CRP levels ≥3 mg/L was 8.31 ( 95 % CI , 4.44 to 15.55 , P < 0.0001 ) compared with those with blood pressure < 120/75 and CRP levels <3 mg/L. After participants had been divided into 4 groups on the basis of CRP levels ( <3 or ≥3 mg/L ) and blood pressure levels ( < 130/85 or ≥130/85 ) , the risk factor – adjusted hazard ratios were as follows : low CRP/low blood pressure , 1.0 ; high CRP/low blood pressure , 1.87 ( P = 0.002 ) ; low CRP/high blood pressure , 2.54 ( P < 0.0001 ) ; and high CRP/high blood pressure , 3.27 ( P < 0.0001 ) . Conclusions —CRP and blood pressure are independent determinants of cardiovascular risk , and their predictive value is additive Abstract Objective : To test the hypothesis that minor chronic insults such as smoking , chronic bronchitis , and two persistent bacterial infections may be associated with increases in C reactive protein concentration within the normal range and that variations in the C reactive protein concentration in turn may be associated with levels of cardiovascular risk factors and chronic coronary heart disease . Design : Population based cross sectional study . Setting : General practice s in Merton , Sutton , and W and sworth . Subjects : A r and om sample of 388 men aged 50 - 69 years from general practice registers . 612 men were invited to attend and 413 attended , of whom 25 non-white men were excluded . The first 303 of the remaining 388 men had full risk factor profiles determined . Interventions : Measurements of  serum C reactive protein concentrations by in house enzyme linked immunosorbent assay ( ELISA ) ; other determinations by st and ard methods . Coronary heart disease was sought by the Rose angina question naire and Minnesota coded electrocardiograms . Main outcome measures : Serum C reactive protein concentrations , cardiovascular risk factor levels , and the presence of coronary heart disease . Results : Increasing age , smoking , symptoms of chronic bronchitis , Helicobacter pylori and Chlamydia pneumoniae infections , and body mass index were all associated with raised concentrations of C reactive protein . C Reactive protein concentration was associated with raised serum fibrinogen , sialic acid , total cholesterol , triglyceride , glucose , and apolipoprotein B values . C Reactive protein concentration was negatively associated with high density lipoprotein cholesterol concentration . There was a weaker positive relation with low density lipoprotein cholesterol concentration and no relation with apolipoprotein A I value . C Reactive protein concentration was also strongly associated with coronary heart disease . Conclusion : The body 's response to inflammation may play an important part in influencing the progression of atherosclerosis . The association of C reactive protein concentration with coronary heart disease needs testing in prospect i ve studies . Key messages Factors that determine levels of inflammatory mediators in the normal general population have not been explored , nor has their relation to cardio- vascular risk factors Among 50 - 69 year old men many environmental and lifestyle risk factors for cardiovascular disease are associated with raised serum concentrations of C reactive protein Circulating concentrations of lipids , glucose , and clotting factors are also associated with serum C reactive protein concentrations The body 's response to inflammation may influence the development of BACKGROUND C-reactive protein ( CRP ) is a sensitive marker of inflammation , and elevated levels have been associated with future risk of myocardial infa rct ion ( MI ) . However , whether measurement of CRP adds to the predictive value of total cholesterol ( TC ) and HDL chol 
    Output:
    
Conclusion Increasing poverty and non-white race was associated with elevated CRP levels among adults .