C-reactive protein and reclassification of cardiovascular risk in the Framingham Heart Study.
C-reactive protein and reclassification of cardiovascular risk in the Framingham Heart Study.
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DOI：
10.1161/circoutcomes.108.831198
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发表时间：
2008-11
期刊：
影响因子：
--
通讯作者：
O'Donnell CJ
中科院分区：
文献类型：
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作者：
Wilson PW;Pencina M;Jacques P;Selhub J;D'Agostino R Sr;O'Donnell CJ
高敏C反应蛋白（CRP）循环水平与心血管疾病（CVD）风险的关系，特别是考虑到中等风险水平的影响，尚未得到充分评估。在3006名无CVD的Frachial Heart研究的后代参与者中（基线时平均年龄46岁），在12年的随访期间有129例硬冠心病（CHD）事件和286例总CVD事件。采用考克斯回归、受试者工作特征曲线下面积判别和净重新分类改善来评估CRP对血管风险的作用。在包括两种性别的年龄调整模型中，新发硬CHD和总CVD的风险比与较高的CRP水平显著相关。类似的分析，根据增加同型半胱氨酸（HCys）水平显示显着的保护性协会，硬冠心病，但不是总心血管疾病。在包括年龄、性别、收缩压、总胆固醇、HDL-胆固醇、糖尿病、当前吸烟、高血压治疗和同型半胱氨酸的多变量分析中，log CRP水平与发生硬CHD和总CVD显著相关，并在事件识别方面提供中度改善。当CRP加入传统因素时，总CVD的净重新分类改善为5.6%（P=0.014），硬CHD为11.8%（P=0.009）。CRP的循环水平有助于估计初始心血管事件的风险，并可能最有效地用于中度血管事件风险的人群，在风险重新分类方面提供适度的改善。
The relationship of circulating levels of high sensitivity C-reactive protein (CRP) with cardiovascular disease (CVD) risk, particularly with consideration of effects at intermediate levels of risk, has not been fully assessed. Among 3006 Offspring participants in the Framingham Heart Study free of CVD (mean age 46 years at baseline), there were 129 Hard coronary heart disease (CHD) events and 286 Total CVD events during 12 years of follow up. Cox regression, discrimination with area under the receiver operating characteristic curve, and net reclassification improvement were used to assess the role of CRP on vascular risk. In an age-adjusted model that included both sexes the hazard ratios for new Hard CHD and Total CVD were significantly associated with higher CRP levels. Similar analyses according to increasing homocysteine (Hcys) level showed significant protective associations for Hard CHD but not for Total CVD. In multivariable analyses that included age, sex, systolic blood pressure, total cholesterol, HDL-cholesterol, diabetes mellitus, current smoking, hypertension treatment and homocysteine, the log CRP level remained significantly related to developing Hard CHD and Total CVD and provided moderate improvement in the discrimination of events. The net reclassification improvement when CRP was added to traditional factors was 5.6% for Total CVD (P=0.014) and 11.8% for Hard CHD (P=0.009). Circulating levels of CRP help to estimate risk for initial cardiovascular events and may be used most effectively in persons at intermediate risk for vascular events, offering moderate improvement in reclassification of risk.