Relation of markers of inflammation (C-reactive protein, fibrinogen, von Willebrand factor, and leukocyte count) and statin therapy to long-term mortality in patients with angiographically proven coronary artery disease
Relation of markers of inflammation (C-reactive protein, fibrinogen, von Willebrand factor, and leukocyte count) and statin therapy to long-term mortality in patients with angiographically proven coronary artery disease
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DOI：
10.1016/s0002-9149(02)02236-1
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发表时间：
2002-04-15
影响因子：
2.8
通讯作者：
Meyer, J
中科院分区：
文献类型：
--
作者：
Bickel, C;Rupprecht, HJ;Meyer, J
我们在1,246例经血管造影诊断为冠心病的患者中评估了他汀类药物与炎症之间可能的相互作用。测定了四种不同的炎症标志物：高敏C反应蛋白（hs-CRP）（p = 0.001）、纤维蛋白原（p = 0.006）、血管性血友病因子（p = 0.006）和白细胞计数（p = 0.03）;随访期间（中位数2.9年）死于心脏原因的88例患者的这些水平显著高于幸存者。在多变量后向逐步考克斯回归模型中，只有hs-CRP被评估为冠心病死亡的显著预测因子。在他汀类药物治疗的患者中，该预测丢失。与接受他汀类药物治疗的患者相比，当hs-CRP水平不升高时，未接受他汀类药物治疗的患者的心源性死亡率并未增加（即使低密度脂蛋白[LDL]水平> 125 mg/dl）。相比之下，未使用他汀类药物且hs-CRP升高（前四分位数）的患者发生致命性冠状动脉事件的风险增加2.3倍，与LDL水平无关。总之，只有hs-CRP升高被选为死亡的独立预测因子。他汀类药物治疗与hs-CRP升高相关，与致死性冠状动脉事件的风险降低无关，与LDL水平无关;这部分可以通过对动脉粥样硬化的抗炎作用来解释。(C)2002年，Excerpta Medica，Inc.
We evaluated a possible interaction between statins and inflammation in 1,246 patients with angiographically diagnosed coronary artery disease. Four different inflammatory markers were determined: high, sensitive C-reactive protein (hs-CRP) (p = 0.001), fibrinogen (p = 0.006), von Willebrand factor (p = 0.006), and leukcocyte count (p = 0.03); these levels were significantly higher among the 88 patients who died of cardiac causes during follow-up (median 2.9 years) than among survivors. In a multivariate backward stepwise Cox regression mode, only hs-CRP was evaluated to be a a significant predictor of death from coronary artery disease. This prediction was lost in statin-treated patients. Compared with patients receiving statin medication, patients without statins did not have increased cardiac mortality (even when low-density lipoprotein [LDL] levels were > 125 mg/dl) when hs-CRP levels were not elevated. In contrast, patients without statins and elevated hs-CRP (top quartile) had a 2.3-fold increase in risk for fatal coronary events, independent of LDL levels. In conclusion, only elevated hs-CRP was selected as an independent predictor of death. Statin therapy is associated with elevated hs-CRP, with a risk reduction for fatal coronary events, independent of LDL levels; this, in part, may be explained by the anti-inflammatory effects on atherosclerosis. (C) 2002 by Excerpta Medica, Inc.