Markers of Atherosclerosis and Inflammation for Prediction of Coronary Heart Disease in Older Adults
Markers of Atherosclerosis and Inflammation for Prediction of Coronary Heart Disease in Older Adults
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DOI：
10.1093/aje/kwp428
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发表时间：
2010-03-01
影响因子：
5
通讯作者：
Newman, Anne B.
中科院分区：
文献类型：
--
作者：
Rodondi, Nicolas;Marques-Vidal, Pedro;Newman, Anne B.
尽管炎症标记物和动脉粥样硬化标记物都与冠心病(CHD)风险相关，但直接比较它们的预测价值的数据有限。比较两种动脉粥样硬化标志物(踝臂指数(AAI)和主动脉脉搏波传导速度(APWV))和三种炎性标志物(C反应蛋白(CRP)、白介素6(IL-6)和肿瘤坏死因子-α(TNF-α))预测冠心病事件的价值。在健康、老龄化和身体成分研究队列中年龄在70-79岁的基线(1997-1998)的2191名成年人中，作者检查了已判定的心肌梗死或冠心病死亡(“硬”事件)和“硬”事件加因心绞痛或冠状动脉血运重建住院(总的CHD事件)。在1997-1998年至2007年6月的8年跟踪调查中，351名参与者发生了总共的CHD事件(197起“硬”事件)。IL-6(最高四分位VS最低：危险比=1.82，95%可信区间：1.33，2.49；P-趋势与0.001)和AAI(AAI<；0.9vs AAI1.01-1.3：危险比=1.57，95%可信区间：1.14，2.18)预测的冠心病事件高于传统危险因素，并略微改善了预测准确性的全球衡量标准。C反应蛋白、肿瘤坏死因子-α和aPWV的相关性较弱。IL-6和AAI分别对6.6%和3.3%的受试者进行了准确的重新分类(P‘s<；0.05)。“硬性”冠心病的结果与此相似，但AAI的重新分类率更高。除传统危险因素外，IL-6和AAI与未来的CHD事件相关，并适度改善老年人的风险预测。
Although both inflammatory and atherosclerosis markers have been associated with coronary heart disease (CHD) risk, data directly comparing their predictive value are limited. The authors compared the value of 2 atherosclerosis markers (ankle-arm index (AAI) and aortic pulse wave velocity (aPWV)) and 3 inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha)) in predicting CHD events. Among 2,191 adults aged 70-79 years at baseline (1997-1998) from the Health, Aging, and Body Composition Study cohort, the authors examined adjudicated incident myocardial infarction or CHD death ("hard" events) and "hard" events plus hospitalization for angina or coronary revascularization (total CHD events). During 8 years of follow-up between 1997-1998 and June 2007, 351 participants developed total CHD events (197 "hard" events). IL-6 (highest quartile vs. lowest: hazard ratio = 1.82, 95% confidence interval: 1.33, 2.49; P-trend < 0.001) and AAI (AAI < 0.9 vs. AAI 1.01-1.30: hazard ratio = 1.57, 95% confidence interval: 1.14, 2.18) predicted CHD events above traditional risk factors and modestly improved global measures of predictive accuracy. CRP, TNF-alpha, and aPWV had weaker associations. IL-6 and AAI accurately reclassified 6.6% and 3.3% of participants, respectively (P's < 0.05). Results were similar for "hard" CHD, with higher reclassification rates for AAI. IL-6 and AAI are associated with future CHD events beyond traditional risk factors and modestly improve risk prediction in older adults.