Ridker Paul M
Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, Mass 02215, USA.
Am Heart J. 2004 Jul;148(1 Suppl):S19-26. doi: 10.1016/j.ahj.2004.04.028.
Advances in vascular biology have shown that inflammation plays an integral role in the development of cardiovascular disease. Extensive study of high-sensitivity C-reactive protein (hs-CRP) has demonstrated that this measure of inflammation predicts cardiovascular risk not reflected by traditional risk factors, adds prognostic information to traditional risk assessment, and predicts long-term cardiovascular risk in individuals with no prior evidence of cardiovascular disease. Patients with elevated hs-CRP levels in the absence of elevated cholesterol appear to derive preventive benefit from statin therapy that is similar in magnitude to that in patients with elevated cholesterol. The large-scale Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosvastatin (JUPITER) trial represents a critical study to determine the utility of a strategy for targeting statin therapy to prevent incident cardiovascular disease in patients at increased cardiovascular risk on the basis of elevated hs-CRP who would not be considered candidates for therapy on the basis of hypercholesterolemia or traditional risk assessment. Inclusion of hs-CRP measurement in risk screening and use of this information to guide preventive therapy could result in a marked improvement in prevention of cardiovascular morbidity and mortality.
血管生物学的进展表明，炎症在心血管疾病的发展中起着不可或缺的作用。对高敏C反应蛋白（hs-CRP）的广泛研究表明，这种炎症指标可预测传统危险因素未反映出的心血管风险，为传统风险评估增添预后信息，并能预测无心血管疾病既往证据个体的长期心血管风险。在胆固醇水平未升高的情况下hs-CRP水平升高的患者，似乎能从他汀类药物治疗中获得与胆固醇水平升高患者相似程度的预防益处。大规模的“他汀类药物在一级预防中的应用合理性：评估瑞舒伐他汀的干预试验（JUPITER）”是一项关键研究，旨在确定基于hs-CRP升高而心血管风险增加、但基于高胆固醇血症或传统风险评估不被视为治疗候选者的患者，采用他汀类药物治疗策略预防心血管疾病的效用。将hs-CRP测量纳入风险筛查并利用该信息指导预防性治疗，可能会显著改善心血管疾病发病率和死亡率预防情况。
