C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women
C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women
复制标题
DOI：
10.1056/nejm200003233421202
复制
发表时间：
2000-03-23
影响因子：
158.5
通讯作者：
Rifai, N
中科院分区：
文献类型：
--
作者：
Ridker, PM;Hennekens, CH;Rifai, N
背景资料：由于炎症被认为在心血管事件的发病机制中起作用，因此已经提出测量炎症标志物作为改善这些事件的风险预测的方法。我们在28名患者中进行了一项前瞻性、巢式病例对照研究，263名表面健康的绝经后妇女，平均随访3年，以评估与基础胰岛素相关的心血管事件风险。炎症标志物的水平。这些标志物包括高敏C反应蛋白（hs-CRP）、血清淀粉样蛋白A、白细胞介素-6和可溶性细胞间粘附分子-1（sICAM-1）。我们还研究了同型半胱氨酸和几个脂质和脂蛋白测量。心血管事件被定义为死于冠心病，非致命性心肌梗死或中风，或需要冠状动脉血运重建procedure.Results：的12个标志物测量，超敏C反应蛋白是最强的单变量预测的心血管事件的风险;与该标志物的最低四分位数相比，最高四分位数女性事件的相对风险为4.4（95%置信区间，2.2 - 8.9）。与心血管事件风险显著相关的其他标志物是血清淀粉样蛋白A（最高四分位数与最低四分位数相比的相对风险，3.0），sICAM-1（2.6），白细胞介素-6（2.2），同型半胱氨酸（2.0），总胆固醇（2.4）、低密度脂蛋白（LDL）胆固醇（2.4）、载脂蛋白B-100（3.4）、高密度脂蛋白（HDL）胆固醇（0.3）和总胆固醇与HDL胆固醇的比率（3.4）。在预测风险方面，除了血脂外，还包括炎症标志物的预测模型明显优于仅基于血脂水平的模型（P
Background: Since inflammation is believed to have a role in the pathogenesis of cardiovascular events, measurement of markers of inflammation has been proposed as a method to improve the prediction of the risk of these events.Methods: We conducted a prospective, nested case-control study among 28,263 apparently healthy postmenopausal women over a mean follow-up period of three years to assess the risk of cardiovascular events associated with base-line levels of markers of inflammation. The markers included high-sensitivity C-reactive protein (hs-CRP), serum amyloid A, interleukin-6, and soluble intercellular adhesion molecule type 1 (sICAM-1). We also studied homocysteine and several lipid and lipoprotein measurements. Cardiovascular events were defined as death from coronary heart disease, nonfatal myocardial infarction or stroke, or the need for coronary-revascularization procedures.Results: Of the 12 markers measured, hs-CRP was the strongest univariate predictor of the risk of cardiovascular events; the relative risk of events for women in the highest as compared with the lowest quartile for this marker was 4.4 (95 percent confidence interval, 2.2 to 8.9). Other markers significantly associated with the risk of cardiovascular events were serum amyloid A (relative risk for the highest as compared with the lowest quartile, 3.0), sICAM-1 (2.6), interleukin-6 (2.2), homocysteine (2.0), total cholesterol (2.4), low-density lipoprotein (LDL) cholesterol (2.4), apolipoprotein B-100 (3.4), high-density lipoprotein (HDL) cholesterol (0.3), and the ratio of total cholesterol to HDL cholesterol (3.4). Prediction models that incorporated markers of inflammation in addition to lipids were significantly better at predicting risk than models based on lipid levels alone (P