High-Sensitivity C-Reactive Protein and Risk of Stroke in Atrial Fibrillation (from the Reasons for Geographic and Racial Differences in Stroke Study).
High-Sensitivity C-Reactive Protein and Risk of Stroke in Atrial Fibrillation (from the Reasons for Geographic and Racial Differences in Stroke Study).
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DOI：
10.1016/j.amjcard.2016.08.069
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发表时间：
2016-12-15
影响因子：
2.8
通讯作者：
Soliman, Elsayed Z.
中科院分区：
文献类型：
--
作者：
Dawood, Farah Z.;Judd, Suzanne;Howard, Virginia J.;Limdi, Nita A.;Meschia, James F.;Cushman, Mary;Howard, George;Herrington, David M.;Soliman, Elsayed Z.
心房颤动(房颤)时炎症和血栓前状态之间的关系是公认的。这表明，高敏C反应蛋白(hs-CRP)作为全身炎症的标志物，在改善房颤患者卒中预测方面具有潜在作用。COX比例风险分析被用来检查25,841名参与者(40%黑人，55%女性)在2003-2007年间有无房颤的情况下发生中风的风险。基线房颤(n=2,132)通过心电图和自我报告的既往内科医生诊断史确定。在8.3年的随访中，对中风事件进行了识别和判定。在随访期间，共有655例突发中风发生。在调整了社会人口学、传统中风危险因素以及使用阿司匹林和华法林后的模型中，hs-CRP水平较高与总体中风风险增加相关(HR(95%CI)：hs-CRP和GT分别为1.30(1.10-1.54)和1.06(1.01-1.12)；3 mg/L和每1标准差(1-SD)增加。在无房颤的患者中，hs-CRP值升高继续与卒中相关(HR(95%CI)：hs-CRP和GT分别为1.31(1.09~1.57)和1.06(1.01~1.12)；hs-CRP和GT分别为3 mg/L和PER 1-SD增加)，而在房颤组中无相关性(HR(95%CI)：1.22(0.78~1.91)和1.01(0.82~1.23)；hs-CRP和GT分别为3 mg/L和PER 1-SD增加)。总而言之，尽管hs-CRP与该人群的卒中风险显著相关，但似乎仅限于那些没有房颤的人群。这些发现表明，超敏C反应蛋白在改善房颤患者卒中风险分层方面的价值有限。
The relationship between inflammation and prothrombotic state in atrial fibrillation (AF) is well recognized. This suggests a potential role for high sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, in improving prediction of stroke in participants with AF. Cox proportional hazard analysis was used to examine the risk of stroke in 25,841 participants (40% black, 55% women) with and without AF who were enrolled in the REGARDS study between 2003 and 2007. Baseline AF (n=2,132) was ascertained by electrocardiogram and self-reported history of previous physician diagnosis. Stroke events were identified and adjudicated during 8.3 years of follow up. A total of 655 incident strokes occurred during follow up. In a model adjusted for socio-demographics, traditional stroke risk factors, and use of aspirin and warfarin, higher levels of hs-CRP were associated with increased overall stroke risk (HR (95%CI): 1.30 (1.10–1.54) and 1.06 (1.01–1.12) for hs-CRP> 3 mg/L and per 1-standard deviation (1-SD) increase, respectively. Higher levels of hs-CRP continued to be associated with incident stroke in participants without AF (HR (95%CI):1.31(1.09–1.57) and 1.06 (1.01–1.12) for hs-CRP> 3 mg/L and per 1-SD increase respectively) but not in those with AF (HR (95%CI): 1.22(0.78–1.91), and 1.01(0.82–1.23), for hs-CRP> 3 mg/L and per 1-SD increase respectively). In conclusion, although hs-CRP was significantly associated with stroke risk in this population, it seems to be limited to those without AF. These findings suggest a limited value of hs-CRP in improving stroke risk stratification in persons with AF.
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影响因子：
39
作者：
Soliman, Elsayed Z.;Safford, Monika M.;Muntner, Paul;Khodneva, Yulia;Dawood, Farah Z.;Zakai, Neil A.;Thacker, Evan L.;Judd, Suzanne;Howard, Virginia J.;Howard, George;Herrington, David M.;Cushman, Mary
通讯作者：
Cushman, Mary
影响因子：
8.7
作者：
Tracy, RP;Lemaitre, RN;Kuller, LH
通讯作者：
Kuller, LH
影响因子：
8.3
作者：
WOLF, PA;ABBOTT, RD;KANNEL, WB
通讯作者：
KANNEL, WB
影响因子：
8.3
作者：
Soliman, Elsayed Z.;Howard, George;Howard, Virginia J.
通讯作者：
Howard, Virginia J.
影响因子：
8.3
作者：
Rost, NS;Wolf, PA;Wilson, PWF
通讯作者：
Wilson, PWF