Mega Jessica L, Morrow David A, Cannon Christopher P, Murphy Sabina, Cairns Richard, Ridker Paul M, Braunwald Eugene
TIMI (Thrombolysis in Myocardial Infarction) Study Group, Boston, Massachusetts 12114, USA.
J Thromb Thrombolysis. 2006 Aug;22(1):71-6. doi: 10.1007/s11239-006-8081-0.
While statins have been shown to reduce cerebrovascular events (CVE), the relationship between cholesterol, C-reactive protein (CRP), and CVE in patients treated with different statin strategies is still being explored.
PROVE IT-TIMI 22 was a randomized trial of intensive (atorvastatin 80 mg/day) and moderate (pravastatin 40 mg/day) statin therapy in 4,162 patients with acute coronary syndromes followed for an average of 24 months; serial biomarkers allowed for an assessment of the lipid and non-lipid effects of statins as they relate to CVE.
In this study, 45 patients on intensive statin therapy and 40 patients on moderate statin therapy had a CVE during the study period (2.1% v. 1.9%, P = 0.62). While the lipid profiles of patients with and without CVE were similar, those with CVE had higher CRP levels at 30 days and 4 months (2.7 v. 1.9, 2.4 v. 1.7 mg/L; P = 0.012, P = 0.005). Day 30 CRP remained an independent predictor of CVE after adjusting for age, development of atrial fibrillation, diabetes, and prior CVE. Patients with low density lipoprotein (LDL) levels < 70 mg/dL and > or = 70 mg/dL had similar rates of CVE, while patients with CRP < 2 mg/L tended to have lower event rates when compared to those with higher levels. The lowest rates of CVE were seen in patients who had LDL < 70 mg/dL and CRP < 2 mg/L.
In PROVE IT--TIMI 22, achieved LDL levels did not appear to independently impact the rate of CVE. In contrast, patients with elevated CRP levels were at higher risk of stroke or transient ischemic attack, reinforcing the link between inflammation and CVE. The goal of this PROVE IT-TIMI 22 sub-study was to examine the relationship between cholesterol, CRP, and CVE in patients on intensive and moderate statin therapy. The achieved lipid levels were similar in patients with and without a CVE; however, the achieved levels of CRP were higher in patients who subsequently developed a stroke or TIA. These findings further support the relationship between inflammation and CVE.
虽然他汀类药物已被证明可降低脑血管事件（CVE），但在接受不同他汀类药物治疗策略的患者中，胆固醇、C反应蛋白（CRP）与CVE之间的关系仍在探索中。
PROVE IT-TIMI 22是一项针对4162例急性冠状动脉综合征患者的强化（阿托伐他汀80毫克/天）和中度（普伐他汀40毫克/天）他汀类药物治疗的随机试验，平均随访24个月；连续的生物标志物可用于评估他汀类药物与CVE相关的脂质和非脂质效应。
在本研究中，45例接受强化他汀类药物治疗的患者和40例接受中度他汀类药物治疗的患者在研究期间发生了CVE（2.1%对1.9%，P = 0.62）。虽然发生和未发生CVE的患者的血脂谱相似，但发生CVE的患者在30天和4个月时的CRP水平较高（2.7对1.9，2.4对1.7毫克/升；P = 0.012，P = 0.005）。在调整年龄、房颤发生、糖尿病和既往CVE后，第30天的CRP仍然是CVE的独立预测因子。低密度脂蛋白（LDL）水平<70毫克/分升和≥70毫克/分升的患者CVE发生率相似，而CRP<2毫克/升的患者与CRP水平较高的患者相比，事件发生率往往较低。CVE发生率最低的是LDL<70毫克/分升且CRP<2毫克/升的患者。
在PROVE IT-TIMI 22中，达到的LDL水平似乎并未独立影响CVE发生率。相比之下，CRP水平升高的患者发生中风或短暂性脑缺血发作的风险更高，这加强了炎症与CVE之间的联系。PROVE IT-TIMI 22子研究的目的是检查强化和中度他汀类药物治疗患者中胆固醇、CRP与CVE之间的关系。发生和未发生CVE的患者达到的血脂水平相似；然而，随后发生中风或短暂性脑缺血发作的患者达到的CRP水平较高。这些发现进一步支持了炎症与CVE之间的关系。
