Engström Gunnar, Melander Olle, Hedblad Bo
Department of Clinical Sciences in Malmö, Lund University, Malmö University Hospital, Sweden.
Arterioscler Thromb Vasc Biol. 2009 Oct;29(10):1691-5. doi: 10.1161/ATVBAHA.109.193490. Epub 2009 Jul 30.
This study explored the relationships between carotid intima-media thickness (IMT), plasma levels of C-reactive protein (CRP), and incidence of heart failure hospitalizations.
Men and women from the general population (n=4691), without history of myocardial infarction or stroke, were examined. Incidence of hospitalizations attributable to heart failure was studied over a mean follow-up of 13 years. A total of 75 subjects were hospitalized with a primary diagnosis of heart failure. Adjusted for risk factors, the hazards ratios (95% CI) were 1.00, 0.98 (0.36 to 2.7), 1.9 (0.80 to 4.6), and 2.7 (1.1 to 6.2), respectively, for the 1st, 2nd, 3rd, and 4th quartiles of IMT (P for trend=0.003). The HR associated with CRP levels >or=3 mg/L (versus <1 mg/L) was 2.0 (95% CI: 1.06 to 3.9) after adjustments for risk factors. There was a significant interaction between IMT and CRP on heart failure incidence (P=0.028). Subjects with CRP >or=3 mg/L and IMT in the 4th quartile had an adjusted HR of 3.7 (1.9 to 7.1) compared to those with CRP <3 mg/L and IMT in quartile 1 to 3.
High IMT and high CRP are both independent risk factors for incidence of heart failure requiring hospitalization. The joint exposure to both risk factors substantially increases the risk.
本研究探讨颈动脉内膜中层厚度（IMT）、血浆C反应蛋白（CRP）水平与心力衰竭住院发生率之间的关系。
对来自普通人群的4691名无心肌梗死或中风病史的男性和女性进行了检查。在平均13年的随访期内研究了因心力衰竭导致的住院发生率。共有75名受试者因心力衰竭的初步诊断而住院。在对风险因素进行调整后，IMT第1、2、3和4四分位数的风险比（95%可信区间）分别为1.00、0.98（0.36至2.7）、1.9（0.80至4.6）和2.7（1.1至6.2）（趋势P值=0.003）。在对风险因素进行调整后，与CRP水平≥3 mg/L（对比<1 mg/L）相关的风险比为2.0（95%可信区间：1.06至3.9）。IMT和CRP在心力衰竭发生率方面存在显著交互作用（P=0.028）。与CRP<3 mg/L且IMT在第1至3四分位数的受试者相比，CRP≥3 mg/L且IMT在第4四分位数的受试者调整后的风险比为3.7（1.9至7.1）。
高IMT和高CRP均是需要住院治疗的心力衰竭发生率的独立危险因素。同时暴露于这两种危险因素会大幅增加风险。
