C-reactive protein, fibrinogen, and cardiovascular disease prediction.
C-reactive protein, fibrinogen, and cardiovascular disease prediction.
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DOI：
10.1056/nejmoa1107477
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发表时间：
2012-10-04
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影响因子：
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通讯作者：
Danesh J
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作者：
Emerging Risk Factors Collaboration;Kaptoge S;Di Angelantonio E;Pennells L;Wood AM;White IR;Gao P;Walker M;Thompson A;Sarwar N;Caslake M;Butterworth AS;Amouyel P;Assmann G;Bakker SJ;Barr EL;Barrett-Connor E;Benjamin EJ;Björkelund C;Brenner H;Brunner E;Clarke R;Cooper JA;Cremer P;Cushman M;Dagenais GR;D'Agostino RB Sr;Dankner R;Davey-Smith G;Deeg D;Dekker JM;Engström G;Folsom AR;Fowkes FG;Gallacher J;Gaziano JM;Giampaoli S;Gillum RF;Hofman A;Howard BV;Ingelsson E;Iso H;Jørgensen T;Kiechl S;Kitamura A;Kiyohara Y;Koenig W;Kromhout D;Kuller LH;Lawlor DA;Meade TW;Nissinen A;Nordestgaard BG;Onat A;Panagiotakos DB;Psaty BM;Rodriguez B;Rosengren A;Salomaa V;Kauhanen J;Salonen JT;Shaffer JA;Shea S;Ford I;Stehouwer CD;Strandberg TE;Tipping RW;Tosetto A;Wassertheil-Smoller S;Wennberg P;Westendorp RG;Whincup PH;Wilhelmsen L;Woodward M;Lowe GD;Wareham NJ;Khaw KT;Sattar N;Packard CJ;Gudnason V;Ridker PM;Pepys MB;Thompson SG;Danesh J
关于评估C反应蛋白（CRP）和其他炎症生物标志物水平对首次心血管事件预测的价值存在争议。我们分析了52项前瞻性研究的数据，其中包括246，669名无心血管疾病史的参与者，以研究将CRP或纤维蛋白原水平添加到传统危险因素中预测心血管风险的价值。我们计算了随访期间的区分和重新分类措施，并在CRP或纤维蛋白原评估后模拟了开始他汀类药物治疗的临床意义。将高密度脂蛋白胆固醇的信息添加到心血管疾病的预后模型中，包括年龄，性别，吸烟状况，血压，糖尿病史和总胆固醇水平，使C指数增加了0.0050。进一步增加CRP或纤维蛋白原的信息使C指数分别增加0.0039和0.0027（P<0.001），并且对于预测的10年风险类别“低”（<10%）、“中等”（<10%）和“中等”（<10%），（10%至<20%）和“高”（≥20%）（两种比较P<0.02）。我们估计，在10万名40岁或40岁以上的成年人中，如果仅使用传统风险因素来计算风险，则最初将15，025人归类为心血管事件的中等风险。假设他汀类药物治疗将根据成人治疗组III指南（即，对于预测风险≥20%的患者和具有某些其他风险因素（如糖尿病，无论其10年预测风险如何）的患者，对13，199名中等风险的剩余参与者进行CRP或纤维蛋白原水平的额外靶向评估可能有助于在10年内预防约30起额外的心血管事件。在一项对没有已知心血管疾病的人进行的研究中，我们估计，根据目前的治疗指南，对心血管事件中度风险人群的CRP或纤维蛋白原水平进行评估，可以帮助每400至500人在10年内预防一次额外的事件。（由英国心脏基金会和其他机构资助。
There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen. The addition of information on high-density lipoprotein cholesterol to a prognostic model for cardiovascular disease that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (P<0.001), and yielded a net reclassification improvement of 1.52% and 0.83%, respectively, for the predicted 10-year risk categories of “low” (<10%), “intermediate” (10% to <20%), and “high” (≥20%) (P<0.02 for both comparisons). We estimated that among 100,000 adults 40 years of age or older, 15,025 persons would initially be classified as being at intermediate risk for a cardiovascular event if conventional risk factors alone were used to calculate risk. Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines (i.e., for persons with a predicted risk of ≥20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years. In a study of people without known cardiovascular disease, we estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened. (Funded by the British Heart Foundation and others.)