C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study
C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study
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DOI：
10.1161/01.cir.0000136581.59584.0e
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发表时间：
2004-07-27
期刊：
影响因子：
37.8
通讯作者：
Wilson, PWF
中科院分区：
文献类型：
--
作者：
Rutter, MK;Meigs, JB;Wilson, PWF
背景-炎症（通过C-反应蛋白[CRP]评估）和代谢综合征（MetS）与心血管疾病（CVD）相关，但基于人群的数据有限。（国家胆固醇教育计划专家小组检测，评估和治疗成人高血胆固醇，在3037名受试者（1681名女性;平均年龄，54岁）中，使用CRP和MetS预测7年内新发CVD事件（n = 189）。24%的受试者存在MetS（大于或等于5个特征中的3个）;具有0、1、2、3、4或5个MetS特征的受试者的平均年龄校正CRP水平分别为2.2、3.5、4.2、6.0或6.6 mg/L（P趋势< 0.0001）。在MetS患者中，女性的年龄校正CRP水平高于男性（7.8 vs 4.6 mg/L; P < 0.0001）。MetS和基线CRP分别与CVD事件相关（MetS：年龄-性别校正的风险比[HR]，2.1; 95% CI，1.5 - 2.8;最高与最低CRP四分位数：HR，2.2; 95% CI，1.4 - 3.5）。即使在包括年龄、性别、MetS（HR，1.8; 95% CI，1.4 - 2.5）和CRP（HR，1.9; 95% CI，1.2 - 2.9）的模型中调整后，MetS和CRP的CVD风险仍较高。与年龄和性别校正模型相关的c-统计量包括CRP为0.72，包括MetS为0.74，包括CRP和MetS为0.74。结论-CRP水平升高与胰岛素抵抗和MetS的存在有关，尤其是在女性中。尽管同时使用MetS和CRP对有CVD事件风险的受试者进行区分并不比单独使用任一表型更好，但CRP和MetS都是新发CVD事件的独立预测因子。
Background-Inflammation (assessed by C-reactive protein [CRP]) and the metabolic syndrome (MetS) are associated with cardiovascular disease (CVD), but population-based data are limited.Methods and Results-We assessed the cross-sectional relations of CRP to the MetS ( National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III definition) in 3037 subjects ( 1681 women; mean age, 54 years) and the utility of CRP and the MetS to predict new CVD events (n = 189) over 7 years. MetS (greater than or equal to3 of 5 traits) was present in 24% of subjects; mean age-adjusted CRP levels for those with 0, 1, 2, 3, 4, or 5 MetS traits were 2.2, 3.5, 4.2, 6.0, or 6.6 mg/L, respectively (P trend < 0.0001). In persons with MetS, age-adjusted CRP levels were higher in women than men (7.8 versus 4.6 mg/L; P < 0.0001). MetS and baseline CRP were individually related to CVD events (for MetS: age-sex-adjusted hazard ratio [HR], 2.1; 95% CI, 1.5 to 2.8; for highest versus lowest CRP quartile: HR, 2.2; 95% CI, 1.4 to 3.5). Greater risk of CVD persisted for MetS and CRP even after adjustment in a model including age, sex, MetS (HR, 1.8; 95% CI, 1.4 to 2.5), and CRP (HR, 1.9; 95% CI, 1.2 to 2.9). The c-statistic associated with the age- and sex-adjusted model including CRP was 0.72; including MetS, 0.74; and including CRP and MetS, 0.74.Conclusions-Elevated CRP levels are related to insulin resistance and the presence of the MetS, especially in women. Although discrimination of subjects at risk of CVD events using both MetS and CRP is not better than using either phenotype alone, both CRP and MetS are independent predictors of new CVD events.