Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack - The Framingham Study
Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack - The Framingham Study
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DOI：
10.1161/hs1101.098151
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发表时间：
2001-11-01
期刊：
影响因子：
8.3
通讯作者：
Wilson, PWF
中科院分区：
文献类型：
--
作者：
Rost, NS;Wolf, PA;Wilson, PWF
背景-C反应蛋白(CRP)作为动脉粥样硬化性血栓性疾病的一种新的血浆标志物的作用目前正在研究中。以前的研究大多将CRP与冠心病联系起来，往往局限于病例对照设计，没有包括相关的危险因素来评估CRP对预后的联合和净影响。在Framingham研究的原始队列中，我们将血浆CRP水平与首次缺血性卒中或短暂性脑缺血发作(TIA)的发生率相关联。方法：在1980-1982年的临床检查中，591名男性和871名女性没有卒中/短暂性脑缺血发作，他们的平均年龄为69.7岁。用酶免疫分析法对先前冷冻的血清样本进行C反应蛋白水平测定。分析是基于性别特定的CRP四分位数。计算风险比(RR)，并进行一系列趋势分析。结果：在12至14年的随访中，共发生196次缺血性卒中和TIA。与年龄无关，CRP四分位数最高的男性患缺血性卒中/短暂性脑缺血发作的风险是男性的2倍(RR=2.0P=0.027)，而女性的风险几乎是最低四分位数的3倍(RR=2.7P=0.0003)。对四分位数风险趋势的评估显示，男性(RR=1.347，P=0.0025)和女性(RR=1.441，P=0.0001)的风险未经调整地增加。在调整吸烟、总胆固醇/高密度脂蛋白、收缩压和糖尿病后，C反应蛋白四分位数的风险增加在男性(P=0.0365)和女性(P=0.0084)中仍然具有统计学意义。结论：血浆C反应蛋白水平升高独立于其他心血管危险因素，显著预测老年患者未来发生缺血性卒中和短暂性脑缺血发作的风险。
Background-The role of C-reactive protein (CRP) as a novel plasma marker of atherothrombotic disease is currently under investigation. Previous studies have mostly related CRP to coronary heart disease, were often restricted to a case-control design, and failed to include pertinent risk factors to evaluate the joint and net effect of CRP on the outcome. We related plasma CRP levels to incidence of first ischemic stroke or transient ischemic attack (TIA) in the Framingham Study original cohort.Methods-There were 591 men and 871 women free of stroke/TIA during their 1980 to 1982 clinic examinations, when their mean age was 69.7 years. CRP levels were measured by using an enzyme immunoassay on previously frozen serum samples. Analyses were based on sex-specific CRP quartiles. Risk ratios (RRs) were derived, and series of trend analyses were performed.Results-During 12 to 14 years of follow-up, 196 ischemic strokes and TIAs occurred. Independent of age, men in the highest CRP quartile had 2 times the risk of ischemic stroke/TIA (RR=2.0, P=0.027), and women had almost 3 times the risk (RR = 2.7, P = 0.0003) compared with those in the lowest quartile. Assessment of the trend in risk across quartiles showed unadjusted risk increase for men (RR=1.347, P=0.0025) and women (RR=1.441, P=0.0001). After adjustment for smoking, total/HDL cholesterol, systolic blood pressure, and diabetes, the increase in risk across CRP quartiles remained statistically significant for both men (P=0.0365) and women (P=0.0084).Conclusions-Independent of other cardiovascular risk factors, elevated plasma CRP levels significantly predict the risk of future ischemic stroke and TIA in the elderly.