Grewal Jasmine, Chan Sammy, Frohlich Jiri, Mancini G B John
Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC.
Clin Invest Med. 2003 Aug;26(4):158-65.
Coronary heart disease (CHD) risk assessed by the Framingham risk score does not take into account the various "novel" markers that are of increasing interest. In this paper we examine a low-risk population to determine which novel markers may be of additive value to the Framingham assessment of CHD risk.
Levels of high-sensitivity C-reactive protein (hs-CRP), soluble vascular cell adhesion molecule (s-VCAM), soluble intercellular adhesion molecule (s-ICAM-1), endothelial selectin (e-selectin), homocysteine and von Willebrand factor (vWF) were measured in 53 apparently healthy subjects recruited from a risk-reduction referral clinic. Carotid intima medial thickness (IMT) and number of plaques were determined by ultrasonography. Brachial ultrasound flow-mediated dilation (FMD) was also measured. Framingham risk scores were calculated and univariate and multivariate analyses of the resulting percent CHD risk over 10 years and novel markers were undertaken.
Abnormal carotid IMT and presence of plaques, hs-CRP, homocysteine, FMD and s-ICAM-1 were detected with a high frequency in this low-risk cohort. Average IMT, number of plaques and homocysteine were highly correlated with the calculated percent CHD whereas measures of hs-CRP, s-ICAM-1 and FMD were independent of the percent CHD calculation.
FMD, as a reflection of the functional status of the vasculature, and hs-CRP and s-ICAM-1, as indicators of inflammatory processes, were independent of Framingham risk assessment in patients at low risk for cardiovascular disease.
通过弗明汉姆风险评分评估的冠心病（CHD）风险未考虑到日益受到关注的各种“新型”标志物。在本文中，我们研究了一个低风险人群，以确定哪些新型标志物可能对弗明汉姆冠心病风险评估具有附加价值。
对从一个降低风险转诊诊所招募的53名表面健康的受试者测量了高敏C反应蛋白（hs-CRP）、可溶性血管细胞粘附分子（s-VCAM）、可溶性细胞间粘附分子（s-ICAM-1）、内皮选择素（e-选择素）、同型半胱氨酸和血管性血友病因子（vWF）的水平。通过超声检查确定颈动脉内膜中层厚度（IMT）和斑块数量。还测量了肱动脉超声血流介导的舒张功能（FMD）。计算弗明汉姆风险评分，并对所得的10年冠心病风险百分比和新型标志物进行单变量和多变量分析。
在这个低风险队列中，颈动脉IMT异常和斑块的存在、hs-CRP、同型半胱氨酸、FMD和s-ICAM-1的检测频率很高。平均IMT、斑块数量和同型半胱氨酸与计算出的冠心病百分比高度相关，而hs-CRP、s-ICAM-1和FMD的测量值与冠心病百分比计算无关。
FMD作为血管系统功能状态的反映，以及hs-CRP和s-ICAM-1作为炎症过程的指标，在心血管疾病低风险患者中独立于弗明汉姆风险评估。
