C-Reactive Protein as a Risk Factor for Coronary Heart Disease: A Systematic Review and Meta-analyses for the US Preventive Services Task Force
C-Reactive Protein as a Risk Factor for Coronary Heart Disease: A Systematic Review and Meta-analyses for the US Preventive Services Task Force
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DOI：
10.7326/0003-4819-151-7-200910060-00009
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发表时间：
2009-10-06
影响因子：
39.2
通讯作者：
Helfand, Mark
中科院分区：
文献类型：
--
作者：
Buckley, David I.;Fu, Rongwei;Helfand, Mark
背景资料：C-反应蛋白（CRP）可能有助于改善冠心病（CHD）的全球风险评估，特别是在仅基于传统危险因素的中度风险人群中。S.预防服务工作组（USPSTF）在确定CRP是否应纳入CHD风险评估指南中的研究。数据来源：MEDLINE检索英文文章（1966年至2007年11月），并辅以评论、相关研究、社论、网站和专家建议的参考清单。当CRP用于中危人群时，与CRP的独立预测能力相关的前瞻性队列、病例队列和巢式病例对照研究。数据提取：纳入的研究进行了审查，根据预定义的标准，每个研究的质量rated.Data Synthesis：的有效性的证据和净效益或损害使用CRP冠心病风险评估。通过荟萃分析确定联合效应的大小。证据的质量、一致性和适用性都很好。对于校正了所有CRP风险变量的良好研究，CRP水平大于3.0 mg/L与CRP水平小于1.0 mg/L相比，CHD事件相对风险的汇总估计值为1.58（95% CI，1.37至1.83）。来自4个大型队列的分析一致发现证据表明，包括CRP改善了最初的中等风险人群的风险分层。C-反应蛋白具有理想的检测特性，并且在中度风险人群中CRP水平升高的患病率方面存在良好的数据。有限的证据表明CRP水平的变化与CHD事件的一级预防有关。局限性：测量CRP风险变量和其他协变量的研究方法不同。在大多数研究中，少数民族和种族人口的代表性很差，限制了普遍性。很少有研究直接评估CRP对中危人群危险性重新分类的影响。结论：强有力的证据表明，CRP与冠心病事件有关。适度的、一致的证据表明，在最初的中危人群中，将CRP加入风险预测模型可以改善风险分层。然而，缺乏足够的证据表明降低CRP水平可以预防CHD事件。
Background: C-reactive protein (CRP) may help to refine global risk assessment for coronary heart disease (CHD), particularly among persons who are at intermediate risk on the basis of traditional risk factors alone.Purpose: To assist the U. S. Preventive Services Task Force (USPSTF) in determining whether CRP should be incorporated into guidelines for CHD risk assessment.Data Sources: MEDLINE search of English-language articles (1966 to November 2007), supplemented by reference lists of reviews, pertinent studies, editorials, and Web sites and by expert suggestions.Study Selection: Prospective cohort, case-cohort, and nested case-control studies relevant to the independent predictive ability of CRP when used in intermediate-risk persons.Data Extraction: Included studies were reviewed according to pre-defined criteria, and the quality of each study was rated.Data Synthesis: The validity of the body of evidence and the net benefit or harm of using CRP for CHD risk assessment were evaluated. The combined magnitude of effect was determined by meta-analysis. The body of evidence is of good quality, consistency, and applicability. For good studies that adjusted for all Framingham risk variables, the summary estimate of relative risk for incident CHD was 1.58 (95% CI, 1.37 to 1.83) for CRP levels greater than 3.0 mg/L compared with levels less than 1.0 mg/L. Analyses from 4 large cohorts were consistent in finding evidence that including CRP improves risk stratification among initially intermediate-risk persons. C-reactive protein has desirable test characteristics, and good data exist on the prevalence of elevated CRP levels in intermediate-risk persons. Limited evidence links changes in CRP level to primary prevention of CHD events.Limitations: Study methods for measuring Framingham risk variables and other covariates varied. Ethnic and racial minority populations were poorly represented in most studies, limiting generalizability. Few studies directly assessed the effect of CRP on risk reclassification in intermediate-risk persons.Conclusion: Strong evidence indicates that CRP is associated with CHD events. Moderate, consistent evidence suggests that adding CRP to risk prediction models among initially intermediate-risk persons improves risk stratification. However, sufficient evidence that reducing CRP levels prevents CHD events is lacking.