10-Year Associations Between Tumor Necrosis Factor Receptors 1 and 2 and Cardiovascular Events in Patients With Stable Coronary Heart Disease: A CLARICOR (Effect of Clarithromycin on Mortality and Morbidity in Patients With Ischemic Heart Disease) Trial Substudy
10-Year Associations Between Tumor Necrosis Factor Receptors 1 and 2 and Cardiovascular Events in Patients With Stable Coronary Heart Disease: A CLARICOR (Effect of Clarithromycin on Mortality and Morbidity in Patients With Ischemic Heart Disease) Trial Substudy
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DOI：
10.1161/jaha.117.008299
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发表时间：
2018-05-01
影响因子：
5.4
通讯作者：
Arnlov, Johan
中科院分区：
文献类型：
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作者：
Carlsson, Axel C.;Ruge, Toralph;Arnlov, Johan
背景 - 我们旨在评估稳定型冠心病患者的肿瘤坏死因子 (TNF)-α 可溶性受体（TNFR1 和 TNFR2）与心血管结局之间的关联和预测能力。方法和结果 - CLARICOR（克拉霉素对缺血性心脏病患者死亡率和发病率的影响）是一项在稳定型冠心病患者中比较克拉霉素与安慰剂的随机临床试验。主要结局是非致命性急性心肌梗死、不稳定心绞痛、脑血管疾病和全因死亡率的复合结果。对患者进行了长达10年的随访；发现样本，那些分配安慰剂的样本（n = 1998 中的 1204 个事件）；和复制样本，那些分配了克拉霉素的样本（n=1979 中的 1220 个事件）。我们使用 Cox 回归调整 C 反应蛋白水平，确定心血管危险因素、肾功能和心血管药物。调整后，较高的血清 TNFR1 和 TNFR2 水平与发现样本中的复合结果相关（每次 SD 增加的风险比，1.13；95% 置信区间，1.05-1.22；TNFR1 P=0.001；风险比，1.16；95% 置信区间，1.08-1.24；P
Background-We aimed to assess the associations and predictive powers between the soluble receptors for tumor necrosis factor (TNF)-alpha (TNFR1 and TNFR2) and cardiovascular outcomes in patients with stable coronary heart disease.Methods and Results-CLARICOR (Effect of Clarithromycin on Mortality and Morbidity in Patients With Ischemic Heart Disease) is a randomized clinical trial comparing clarithromycin with placebo in patients with stable coronary heart disease. The primary outcome was a composite of nonfatal acute myocardial infarction, unstable angina pectoris, cerebrovascular disease, and all-cause mortality. Patients were followed up for 10 years; discovery sample, those assigned placebo (1204 events in n=1998); and replication sample, those assigned clarithromycin (1220 events in n=1979). We used Cox regression adjusted for C-reactive protein level, established cardiovascular risk factors, kidney function, and cardiovascular drugs. After adjustments, higher serum levels of TNFR1 and TNFR2 were associated with the composite outcome in the discovery sample (hazard ratio per SD increase, 1.13; 95% confidence interval, 1.05-1.22; P=0.001 for TNFR1; hazard ratio, 1.16; 95% confidence interval, 1.08-1.24; P