The relative strength of C-reactive protein and lipid levels as determinants of ischemic stroke compared with coronary heart disease in women
The relative strength of C-reactive protein and lipid levels as determinants of ischemic stroke compared with coronary heart disease in women
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DOI：
10.1016/j.jacc.2006.09.030
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发表时间：
2006-12-05
影响因子：
24
通讯作者：
Ridker, Paul M.
中科院分区：
文献类型：
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作者：
Everett, Brendan M.;Kurth, Tobias;Ridker, Paul M.
我们试图确定高敏C-反应蛋白（hs-CRP）和血脂水平作为女性缺血性卒中与冠心病（CHD）相比的标志物的相对强度。背景虽然hs-CRP和血脂水平是血管疾病的既定风险决定因素，但这些标志物与CHD相比的相对强度尚不确定。对632名最初健康的女性进行了为期10年的随访，我们比较了hs-CRP、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（NLP）、（非HDL-C）、高密度脂蛋白胆固醇（HDLC）、载脂蛋白A-I和B100，结果在校正年龄、吸烟状况、血压、糖尿病和肥胖等因素后，与CHD相比，未来缺血性卒中的第三个与第一个三分位数的风险比（HR）和95%置信区间（CI）分别为，1.91（95% CI 1.13 - 3.21）和2.26（95% CI 1.64 - 3.12）TC，1.29（95% CI 0.83 - 2.02）和2.09（95% CI 1.53 - 2.85）LDL-C，0.57（95% CI 0.36 - 0.92）和0.38（95% CI 0.27 - 0.52）HDL-C，1.72（95% CI 1.03至2.86）和2.93（95% CI 2.04至4.21），hs-CRP为2.76（95% CI 1.51至5.05）和1.66（95% CI 1.17至2.34）。在血脂比值中，TC/HDL-C比值对缺血性卒中和CHD的HR最大（HR分别为1.95 [95%CI 1.16 - 3.26]和4.20 [95%CI 2.79 - 6.32]）。结论在这个最初健康女性的大型前瞻性队列中，血脂水平是缺血性卒中的重要风险决定因素，但其作用幅度小于对CHD观察到的作用幅度。高敏C反应蛋白与缺血性脑卒中的关系比与冠心病的关系更密切。同时评估血脂水平和hs-CRP可能改善卒中和CHD的风险评估。
OBJECTIVES We sought to determine the relative strength of high-sensitivity C-reactive protein (hs-CRP) and lipid levels as markers for future ischemic stroke compared with coronary heart disease (CHD) in women.BACKGROUND Although hs-CRP and lipid levels are established risk determinants for vascular disease, the relative strength of these biomarkers for ischemic stroke compared with CHD is uncertain.METHODS Among 15,632 initially healthy women who were followed for a 10-year period, we compared hs-CRP, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDLC), apolipoproteins A-I and B100, and lipid ratios as determinants of ischemic stroke compared with CHD.RESULTS After adjustment for age, smoking status, blood pressure, diabetes, and obesity, the hazard ratios (HRs) and 95% confidence intervals (CIs) for the third versus the first tertile for future ischemic stroke compared with CHD were, respectively, 1.91 (95% CI 1.13 to 3.21) and 2.26 (95% CI 1.64 to 3.12) for TC, 1.29 (95% CI 0.83 to 2.02) and 2.09 (95% CI 1.53 to 2.85) for LDL-C, 0.57 (95% CI 0.36 to 0.92) and 0.38 (95% CI 0.27 to 0.52) for HDL-C, 1.72 (95% CI 1.03 to 2.86) and 2.93 (95% CI 2.04 to 4.21) for non-HDL-C, and 2.76 (95% CI 1.51 to 5.05) and 1.66 (95% CI 1.17 to 2.34) for hs-CRP. Of the lipid ratios, that of TC to HDL-C had the largest HR for both future ischemic stroke and CHD (HR 1.95 [95% CI 1.16 to 3.26] and 4.20 [95% CI 2.79 to 6.32], respectively).CONCLUSIONS In this large prospective cohort of initially healthy women, lipid levels are significant risk determinants for ischemic stroke, but with a magnitude of effect smaller than that observed for CHD. High-sensitiviy CRP associates more closely with ischemic stroke than with CHD. Concomitant evaluation of lipid levels and hs-CRP may improve risk assessment for stroke as well as CHD.