Aspirin adherence, aspirin dosage, and C-reactive protein in the first 3 months after acute coronary syndrome.
Aspirin adherence, aspirin dosage, and C-reactive protein in the first 3 months after acute coronary syndrome.
复制标题
急性冠状动脉综合征后前 3 个月的阿司匹林依从性、阿司匹林剂量和 C 反应蛋白。
DOI：
10.1016/j.amjcard.2010.06.018
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Davidson,KarinaW
中科院分区：
文献类型：
--
作者：
Kronish,IanM;Rieckmann,Nina;Shimbo,Daichi;Burg,Matthew;Davidson,KarinaW
炎症标志物如c反应蛋白（CRP）的持续升高与急性冠状动脉综合征（ACS）后心脏事件复发的风险增加有关。关于阿司匹林是否能降低ACS后的CRP，目前有相互矛盾的证据。我们调查了阿司匹林的剂量和依从性是否与ACS后3个月的CRP水平相关。在ACS发生1周内纳入的105例患者中，使用储存在药瓶盖中的电子芯片监测阿司匹林的依从性3个月。在基线和3个月时测量CRP水平。采用Logistic回归分析，在控制年龄、ACS类型、疾病合发、基线CRP水平、氯吡格雷和他汀类药物的使用、抑郁症状、吸烟和其他药物依从性的情况下，检验阿司匹林依从性差和阿司匹林剂量较低是否与CRP水平升高相关。阿司匹林依从性与3个月时CRP水平呈负相关（Spearman’s r = - 0.36, p <0.001）。在调整后的模型中，阿司匹林依从性每降低10%，3个月时CRP水平≥3.0 mg/L的风险增加1.7（95%置信区间1.2 - 2.4）。低剂量阿司匹林与CRP水平≥3.0 mg/L的风险增加7.1（95%可信区间1.5 ~ 33.3）相关。Charlson共发病指数、抑郁症状和基线CRP水平也可预测3个月时CRP水平≥3.0 mg/L。阿司匹林依从性和CRP水平之间的关联并没有通过控制其他降低风险的行为而减弱。总之，ACS后阿司匹林依从性与CRP水平之间存在很强的相关性。
Persistent elevation of inflammatory markers such as C-reactive protein (CRP) has been associated with an increased risk of recurrent cardiac events after acute coronary syndromes (ACS). Conflicting evidence is available regarding whether aspirin can reduce CRP after ACS. We investigated whether the dosage and adherence to aspirin was associated with the CRP level 3 months after ACS. Adherence to aspirin was monitored for 3 months in a cohort of 105 patients enrolled within 1 week of an ACS using an electronic chip stored in the pill bottle cap. The CRP level was measured at baseline and 3 months. Logistic regression analysis was used to test whether poor adherence to aspirin and a lower aspirin dosage were associated with increased CRP levels, controlling for age, ACS type, disease co-morbidity, baseline CRP level, use of clopidogrel and statins, depressive symptoms, smoking, and adherence to other medications. Aspirin adherence was inversely correlated with the CRP level at 3 months (Spearman's r = −0.36, p <0.001). In the adjusted model, every 10% decrease in aspirin adherence was associated with a 1.7 increased risk (95% confidence interval 1.2 to 2.4) of a CRP level of ≥3.0 mg/L at 3 months. Low-dose aspirin was associated with a 7.1 increased risk (95% confidence interval 1.5 to 33.3) of a CRP level of ≥3.0 mg/L. The Charlson co-morbidity index, depressive symptoms, and baseline CRP level were also predictive of a CRP level of ≥3.0 mg/L at 3 months. The association between aspirin adherence and CRP level was not attenuated by controlling for other risk-reducing behaviors. In conclusion, a strong association was found between aspirin adherence and the CRP level after an ACS.