Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels
Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels
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DOI：
10.1161/01.cir.98.9.839
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发表时间：
1998-09-01
期刊：
影响因子：
37.8
通讯作者：
Braunwald, E
中科院分区：
文献类型：
--
作者：
Ridker, PM;Rifai, N;Braunwald, E
背景--我们研究了心肌梗死(MI)后的炎症是否是复发冠状动脉事件的危险因素，以及普伐他汀随机治疗是否降低了这种风险。方法和结果-采用嵌套病例对照设计，比较了胆固醇和复发事件(CARE)试验中391名随后发展为复发性非致命性心肌梗死或致命冠状动脉事件(病例)的随机前体血样本中C-反应蛋白(CRP)和血清淀粉样蛋白(SAA)水平，并与年龄和性别匹配、在随访期间未发生这些事件的参与者(对照组)进行比较。总体而言，CRP值和SAA值均高于对照组(CRP值分别为P=0.006；SAA值分别为1.77和1.74，P=0.02)，复发事件的相对危险度(RR)较低值组高75%。风险最高的研究组是有一致的炎症证据(C反应蛋白和SA升高)的研究小组，他们被随机分配到安慰剂组(RR=2.81P=0.007)；这一风险估计值大于单独与炎症或安慰剂分配相关的个体风险的乘积。在分层分析中，炎症和风险之间的相关性在随机服用安慰剂的患者中显著(RR=2.11，P=0.048)，但在随机服用普伐他汀的患者中减弱，没有显著意义(RR=1.2 9，P=0.5)。结论--MI后炎症的证据与冠状动脉事件复发的风险增加相关。普伐他汀治疗可以降低这一风险，这一观察结果与该药的非脂类作用一致。
Background-We studied whether inflammation after myocardial infarction (MI) is a risk factor for recurrent coronary events and whether randomized treatment with pravastatin reduces that risk.Methods and Results-A nested case-control design was used to compare C-reactive protein (CRP) and serum amyloid A (SAA) levels in prerandomization blood samples from 391 participants in the Cholesterol and Recurrent Events (CARE) trial who subsequently developed recurrent nonfatal MI or a fatal coronary event (cases) and from an equal number of age- and sex-matched participants who remained free of these events during follow-up (control subjects). Overall, CRP and SAA were higher among cases than control subjects (for CRP P=0.05; for SAA P=0.006) such that those with levels in the highest quintile had a relative risk (RR) of recurrent events 75% higher than those with levels in the lowest quintile (for CRP RR=1.77, P=0.02; for SAA RR=1.74, P=0.02). The study group with the highest risk was that with consistent evidence of inflammation (elevation of both CRP and SAA) who were randomly assigned to placebo (RR=2.81, P=0.007); this risk estimate was greater than the product of the individual risks associated with inflammation or placebo assignment alone. In stratified analyses, the association between inflammation and risk was significant among those randomized to placebo (RR=2.11, P=0.048) but was attenuated and nonsignificant among those randomized to pravastatin (RR=1.29, P=0.5),Conclusions-Evidence of inflammation after MI is associated with increased risk of recurrent coronary events. Therapy with pravastatin may decrease this risk, an observation consistent with a nonlipid effect of this agent.