Ridker Paul M, Cook Nancy
Donald W. Reynolds Center for Cardiovascular Research and the Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02215, USA.
Circulation. 2004 Apr 27;109(16):1955-9. doi: 10.1161/01.CIR.0000125690.80303.A8. Epub 2004 Mar 29.
High-sensitivity C-reactive protein (hsCRP) is a strong independent risk factor for cardiovascular events, and levels of hsCRP of <1, 1 to <3, and > or =3 mg/L have been suggested to define low-, moderate-, and high-risk groups. However, the positive predictive value of very low (<0.5 mg/L) and very high levels of hsCRP (>10.0 mg/L) is uncertain.
Baseline levels of hsCRP were evaluated among 27 939 apparently healthy women who were followed up for myocardial infarction, stroke, coronary revascularization, or cardiovascular death. Crude and Framingham Risk Score (FRS)-adjusted relative risks (RRs) of incident cardiovascular events were calculated across a full range of hsCRP levels. Cardiovascular risks increased linearly from the very lowest (referent) to the very highest levels of hsCRP. Crude RRs for those with baseline hsCRP levels of <0.5, 0.5 to <1.0, 1.0 to <2.0, 2.0 to <3.0, 3.0 to <4.0, 4.0 to <5.0, 5.0 to <10.0, 10.0 to <20.0, and > or =20.0 mg/L were 1.0, 2.2, 2.5, 3.1, 3.7, 4.2, 4.9, 6.3, and 7.6, respectively (P for trend <0.001). After adjustment for FRS, these risks were 1.0, 1.6, 1.6, 1.7, 1.9, 2.2, 2.3, 2.8, and 3.1 (P for trend <0.001). All risk estimates remained significant in analyses stratified by FRS and after control for diabetes. Of the total cohort, 15.1% had hsCRP <0.50 mg/L, and 5.4% had hsCRP >10.0 mg/L.
Both very low (<0.5 mg/L) and very high (>10 mg/L) levels of hsCRP provide important prognostic information on cardiovascular risk. hsCRP is clinically useful for risk prediction across a full range of values and across a full range of FRS.
高敏C反应蛋白（hsCRP）是心血管事件的一个强有力的独立危险因素，有人建议将hsCRP水平<1mg/L、1至<3mg/L以及≥3mg/L定义为低、中、高风险组。然而，hsCRP极低（<0.5mg/L）和极高（>10.0mg/L）水平的阳性预测价值尚不确定。
对27939名看似健康的女性进行了hsCRP基线水平评估，并对她们进行心肌梗死、中风、冠状动脉血运重建或心血管死亡方面的随访。计算了整个hsCRP水平范围内心血管事件发生的粗相对风险（RR）和经Framingham风险评分（FRS）调整后的相对风险。心血管风险从hsCRP的最低水平（参照值）到最高水平呈线性增加。基线hsCRP水平<0.5mg/L、0.5至<1.0mg/L、1.0至<2.0mg/L、2.0至<3.0mg/L、3.0至<4.0mg/L、4.0至<5.0mg/L、5.0至<10.0mg/L、10.0至<20.0mg/L以及≥20.0mg/L者的粗RR分别为1.0、2.2、2.5、3.1、3.7、4.2、4.9、6.3和7.6（趋势P<0.001）。经FRS调整后，这些风险分别为1.0、1.6、1.6、1.7、1.9、2.2、2.3、2.8和3.1（趋势P<0.001）。在按FRS分层的分析以及控制糖尿病后，所有风险估计值仍具有显著性。在整个队列中，15.1%的人hsCRP<0.50mg/L，5.4%的人hsCRP>10.0mg/L。
hsCRP极低（<0.5mg/L）和极高（>10mg/L）水平均能提供有关心血管风险的重要预后信息。hsCRP在整个值范围以及整个FRS范围内对风险预测均具有临床实用性。
