Lipoprotein-associated phospholipase A2 as an independent predictor of coronary heart disease.
Lipoprotein-associated phospholipase A2 as an independent predictor of coronary heart disease.
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DOI：
10.1056/nejm200010193431603
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发表时间：
2000-10-19
影响因子：
158.5
通讯作者：
Lowe, GDO
中科院分区：
文献类型：
--
作者：
Packard, CJ;O'Reilly, DSJ;Lowe, GDO
背景资料：慢性炎症被认为通过使冠状动脉血管中的动脉粥样硬化斑块易于破裂而增加冠状动脉事件的风险。我们检查了可能受炎症影响的血液成分作为高胆固醇血症男性的风险预测因子，这些男性参加了苏格兰西部冠状动脉预防研究，该试验评估了普伐他汀在预防冠状动脉事件中的价值。共有580名患有冠心病的男性（非致死性心肌梗死、冠心病死亡或血运重建术）分别与2名对照受试者的年龄和吸烟状况相匹配（共1160例）来自同一队列，未发生冠状动脉事件。脂蛋白相关磷脂酶A（2）、C-反应蛋白、纤维蛋白原水平和白细胞计数在基线水平进行测量，沿着其他传统的危险因素。这些变量与冠状动脉事件的风险的关联进行了测试，回归模型和划分的范围内的值根据quintiles.Results：C-反应蛋白，白细胞计数，纤维蛋白原水平的水平是强有力的预测冠状动脉事件的风险，在最高的五分之一的研究队列中的每个变量的风险约为最低的五分之一的两倍。然而，当年龄、收缩压和脂蛋白水平被纳入多变量模型时，这些变量与风险的相关性明显减弱。脂蛋白相关磷脂酶A（2）（血小板活化因子乙酰水解酶）的水平，其表达受炎症介质的调节，与风险有很强的正相关性，不受其他因素的干扰。它与最高的五分之一的风险几乎增加了一倍相比，最低的五分之一。结论：炎症标志物是冠状动脉事件的风险的预测因子，但其预测能力减弱协会与其他冠状动脉危险因素。脂蛋白相关磷脂酶A（2）水平升高似乎是冠心病的一个强有力的危险因素，这一发现对动脉粥样硬化形成和风险评估有意义。（N Engl J Med 2000;343：1148-55.）(C)2000年马萨诸塞州医学会。
Background: Chronic inflammation is believed to increase the risk of coronary events by making atherosclerotic plaques in coronary vessels prone to rupture. We examined blood constituents potentially affected by inflammation as predictors of risk in men with hypercholesterolemia who were enrolled in the West of Scotland Coronary Prevention Study, a trial that evaluated the value of pravastatin in the prevention of coronary events.Methods: A total of 580 men who had had a coronary event (nonfatal myocardial infarction, death from coronary heart disease, or a revascularization procedure) were each matched for age and smoking status with 2 control subjects (total, 1160) from the same cohort who had not had a coronary event. Lipoprotein-associated phospholipase A(2), C-reactive protein, and fibrinogen levels and the white-cell count were measured at base line, along with other traditional risk factors. The association of these variables with the risk of coronary events was tested in regression models and by dividing the range of values according to quintiles.Results: Levels of C-reactive protein, the white-cell count, and fibrinogen levels were strong predictors of the risk of coronary events; the risk in the highest quintile of the study cohort for each variable was approximately twice that in the lowest quintile. However, the association of these variables with risk was markedly attenuated when age, systolic blood pressure, and lipoprotein levels were included in multivariate models. Levels of lipoprotein-associated phospholipase A(2) (platelet-activating factor acetylhydrolase), the expression of which is regulated by mediators of inflammation, had a strong, positive association with risk that was not confounded by other factors. It was associated with almost a doubling of the risk in the highest quintile as compared with the lowest quintile.Conclusions: Inflammatory markers are predictors of the risk of coronary events, but their predictive ability is attenuated by associations with other coronary risk factors. Elevated levels of lipoprotein-associated phospholipase A(2) appear to be a strong risk factor for coronary heart disease, a finding that has implications for atherogenesis and the assessment of risk. (N Engl J Med 2000;343:1148-55.) (C) 2000 Massachusetts Medical Society.