Hackam Daniel G, Anand Sonia S
Population Health Research Institute and Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
JAMA. 2003 Aug 20;290(7):932-40. doi: 10.1001/jama.290.7.932.
Atherosclerotic vascular disease is an enormous public health problem. A number of emerging risk factors for atherosclerosis have recently been proposed to help identify high-risk individuals.
To review the epidemiological, basic science, and clinical trial evidence concerning 4 emerging risk factors: C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine.
Using the terms atherosclerosis, cardiovascular disease, risk factors, prevention, screening, C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine, we searched the MEDLINE database from January 1990 to January 2003. Conference proceedings, abstract booklets, bibliographies of pertinent articles and books, and personal files were hand searched to identify additional articles.
Original investigations and reviews of the epidemiology of atherosclerosis and the association of conventional and novel risk factors with vascular risk were selected. On the basis of the search strategy, 373 relevant studies were identified.
A diverse array of studies were examined, including randomized controlled trials, prospective cohort studies, systematic overviews, case-control, cross-sectional, and mechanistic studies. Data extraction was performed by one of the authors.
The available epidemiological and basic science evidence supports, to varying degrees, independent associations between these 4 candidate risk factors and atherosclerotic vascular disease. However, there is relatively little data regarding the additive yield of screening for these factors over that of validated global risk assessment strategies currently in use. Furthermore, controlled intervention studies targeting individuals with these factors for proven risk-reduction therapies, or specifically treating these factors with available therapies, are few. The explanatory power of the major, established cardiovascular risk factors has been systematically underestimated.
Although C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine are associated with vascular disease risk, their optimal use in routine screening and risk stratification remains to be determined.
动脉粥样硬化性血管疾病是一个巨大的公共卫生问题。最近提出了一些新的动脉粥样硬化危险因素，以帮助识别高危个体。
综述有关4种新出现的危险因素（C反应蛋白、脂蛋白(a)、纤维蛋白原和同型半胱氨酸）的流行病学、基础科学和临床试验证据。
使用动脉粥样硬化、心血管疾病、危险因素、预防、筛查、C反应蛋白、脂蛋白(a)、纤维蛋白原和同型半胱氨酸等术语，检索了1990年1月至2003年1月的MEDLINE数据库。通过手工检索会议论文集、摘要小册子、相关文章和书籍的参考文献以及个人档案，以识别其他文章。
选择了关于动脉粥样硬化流行病学以及传统和新危险因素与血管风险关联的原始研究和综述。根据检索策略，共识别出373项相关研究。
检查了一系列不同的研究，包括随机对照试验、前瞻性队列研究、系统综述、病例对照研究、横断面研究和机制研究。数据提取由一位作者完成。
现有流行病学和基础科学证据在不同程度上支持这4种候选危险因素与动脉粥样硬化性血管疾病之间的独立关联。然而，与目前使用的经过验证的全球风险评估策略相比，关于筛查这些因素的附加收益的数据相对较少。此外，针对具有这些因素的个体进行已证实的降低风险治疗的对照干预研究，或使用现有疗法专门治疗这些因素的研究很少。主要的、已确定的心血管危险因素的解释力被系统地低估了。
虽然C反应蛋白、脂蛋白(a)、纤维蛋白原和同型半胱氨酸与血管疾病风险相关，但它们在常规筛查和风险分层中的最佳应用仍有待确定。
