High-sensitivity C-reactive protein predicts mortality but not stroke The Northern Manhattan Study
High-sensitivity C-reactive protein predicts mortality but not stroke The Northern Manhattan Study
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DOI：
10.1212/wnl.0b013e3181bd10bc
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发表时间：
2009-10-20
期刊：
影响因子：
9.9
通讯作者：
Sacco, R. L.
中科院分区：
文献类型：
--
作者：
Elkind, M. S. V.;Luna, J. M.;Sacco, R. L.
目的：在一项前瞻性队列研究中确定高敏C反应蛋白（hsCRP）和血清淀粉样蛋白A（SAA）是否可预测卒中、血管事件和死亡率。背景：炎症标志物与心肌梗死（MI）的风险相关。方法：北方曼哈顿研究包括一项无卒中的社区队列研究，参与者年龄≥ 40岁（中位随访7.9年）。采用散射比浊法测定hsCRP和SAA。考克斯比例风险模型用于计算危险比（HR）和95%置信区间（CI），用于调整人口统计学和风险因素后，标志物与缺血性卒中风险和其他结局的相关性。（平均年龄68.9 ± 10.1岁; 64.2%为女性; 18.8%为白色，23.5%为黑人，55.1%为西班牙裔）。中位hsCRP为2.5 mg/L。与hsCRP < 1 mg/L的患者相比，hsCRP > 3 mg/L的患者在人口统计学校正后缺血性卒中的风险增加（HR = 1.60，95% CI 1.06 - 2.41），但在校正其他危险因素后，这种影响减弱（校正后HR = 1.20，95% CI 0.78-1.86）。hsCRP > 3 mg/L与MI（校正HR = 1.70，95% CI 1.04-2.77）和死亡（校正HR = 1.55，95% CI 1.23-1.96）风险相关。SAA与卒中风险无关。结论：在这个多种族队列中，高敏C反应蛋白（hsCRP）与缺血性卒中无关，但与心肌梗死和死亡率适度相关。hsCRP和血清淀粉样蛋白A的值可能取决于人群特征，如年龄和其他危险因素。神经病学（R）2009;73：1300-1307
Objective: To determine whether high-sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA) predict stroke, vascular events, and mortality in a prospective cohort study. Background: Markers of inflammation have been associated with risk of myocardial infarction (MI). Their association with stroke is controversial.Methods: The Northern Manhattan Study includes a stroke-free community-based cohort study in participants aged >= 40 years (median follow-up 7.9 years). hsCRP and SAA were measured using nephelometry. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of markers with risk of ischemic stroke and other outcomes after adjusting for demographics and risk factors.Results: hsCRP measurements were available in 2,240 participants (mean age 68.9 +/- 10.1 years; 64.2% women; 18.8% white, 23.5% black, and 55.1% Hispanic). The median hsCRP was 2.5 mg/L. Compared with those with hsCRP < 1 mg/L, those with hsCRP > 3 mg/L were at increased risk of ischemic stroke in a model adjusted for demographics (HR = 1.60, 95% CI 1.062.41), but the effect was attenuated after adjusting for other risk factors (adjusted HR = 1.20, 95% CI 0.78-1.86). hsCRP > 3 mg/L was associated with risk of MI (adjusted HR = 1.70, 95% CI 1.04-2.77) and death (adjusted HR = 1.55, 95% CI 1.23-1.96). SAA was not associated with stroke risk.Conclusion: In this multiethnic cohort, high-sensitivity C-reactive protein (hsCRP) was not associated with ischemic stroke, but was modestly associated with myocardial infarction and mortality. The value of hsCRP and serum amyloid A may depend on population characteristics such as age and other risk factors. Neurology (R) 2009;73:1300-1307