Circulating Progenitor Cell Count for Cardiovascular Risk Stratification: A Pooled Analysis
Circulating Progenitor Cell Count for Cardiovascular Risk Stratification: A Pooled Analysis
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DOI：
10.1371/journal.pone.0011488
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发表时间：
2010-07-09
期刊：
影响因子：
3.7
通讯作者：
Werner, Nikos
中科院分区：
文献类型：
--
作者：
Fadini, Gian Paolo;Maruyama, Shoichi;Werner, Nikos
背景：循环祖细胞 (CPC) 有助于血管壁的稳态，CPC 计数减少可预测心血管发病率和死亡率。我们测试了 CPC 计数改善心血管风险分层的假设，并且这是由低度炎症调节的。方法/主要发现：我们汇总了 4 项纵向研究的数据，包括总共 1,057 名确定了 CPC 并收集了主要不良心血管事件 (MACE) 的患者。我们记录了心血管危险因素和高敏 C 反应蛋白 (hsCRP) 水平。风险估计源自 Cox 比例风险分析。 CPC 计数和/或 hsCRP 水平被添加到参考模型中，包括年龄、性别、心血管危险因素、流行的 CVD、慢性肾功能衰竭 (CRF) 和药物。样本由高危人群组成，76.3% 的人患有普遍的 CVD，31.6% 的人患有 CRF。在平均 1.7 +/- 1.1 年的随访时间内，发生了 331 起 (31.3%) 次 MACE 事件。即使在 hsCRP 校正后，CPC 计数仍与 MACE 事件独立相关。根据 C-statistics，包括 CPC 在内的模型对 MACE 预测的准确性没有显着改善。然而，综合辨别改进指数（IDI）显示，与参考模型和包括 hsCRP 的模型相比，包括 CPC 的模型在识别 MACE 方面具有更好的性能。 CPC 计数还为 CV 死亡、非致命性 AMI 和其他 CV 事件带来了显着的净重分类改善 (NRI)。 CPC 的影响独立于 hsCRP，但在预测 MACE 事件时，低 CPC 计数与升高的 hsCRP 水平之间存在显着的大于相加的相互作用。结论/意义：在高风险个体中，降低 CPC 计数有助于识别更多短期内处于较高 MACE 风险的患者，特别是与升高的 hsCRP 水平相结合。
Background: Circulating progenitor cells (CPC) contribute to the homeostasis of the vessel wall, and a reduced CPC count predicts cardiovascular morbidity and mortality. We tested the hypothesis that CPC count improves cardiovascular risk stratification and that this is modulated by low-grade inflammation.Methodology/Principal Findings: We pooled data from 4 longitudinal studies, including a total of 1,057 patients having CPC determined and major adverse cardiovascular events (MACE) collected. We recorded cardiovascular risk factors and high-sensitive C-reactive protein (hsCRP) level. Risk estimates were derived from Cox proportional hazard analyses. CPC count and/or hsCRP level were added to a reference model including age, sex, cardiovascular risk factors, prevalent CVD, chronic renal failure (CRF) and medications. The sample was composed of high-risk individuals, as 76.3% had prevalent CVD and 31.6% had CRF. There were 331 (31.3%) incident MACE during an average 1.7 +/- 1.1 year follow-up time. CPC count was independently associated with incident MACE even after correction for hsCRP. According to C-statistics, models including CPC yielded a non-significant improvement in accuracy of MACE prediction. However, the integrated discrimination improvement index (IDI) showed better performance of models including CPC compared to the reference model and models including hsCRP in identifying MACE. CPC count also yielded significant net reclassification improvements (NRI) for CV death, non-fatal AMI and other CV events. The effect of CPC was independent of hsCRP, but there was a significant more-than-additive interaction between low CPC count and raised hsCRP level in predicting incident MACE.Conclusions/Significance: In high risk individuals, a reduced CPC count helps identifying more patients at higher risk of MACE over the short term, especially in combination with a raised hsCRP level.