INSERM U970, Paris Cardiovascular Research Center, Paris, France.
J Am Geriatr Soc. 2010 Jan;58(1):129-35. doi: 10.1111/j.1532-5415.2009.02625.x. Epub 2009 Dec 9.
To assess the association between systemic C-reactive protein (CRP) and incident coronary heart disease (CHD) in community-dwelling elderly people.
A French population-based multicenter prospective cohort study.
Three cities in France: Bordeaux in the southwest, Dijon in the northeast, and Montpellier in the southeast.
After 4 years of follow-up, a case-cohort study was designed including 1,004 subjects randomly selected from the initial cohort of 9,294 subjects free of CHD at baseline and 174 subjects who developed first CHD events during follow-up.
Hazard ratios (HRs) were estimated using a Cox proportional hazard model adapted for the case-cohort design using a CRP level less than 1 mg/L as the reference category.
Of the random sample, 24.3% had a CRP level less than 1.0 mg/L, 45.8% had a CRP level of 1.0 to 2.9 mg/L, and 29.9% had a CRP level of 3.0 to 10.0 mg/L. The HRs for CHD, adjusted for age, sex, and study center, were 1.69 (95% confidence interval (CI)=1.04-2.75) for CRP from 1.0 to 2.9 mg/L and 2.32 (95% CI=1.41-3.82) for CRP from 3.0 to 10.0 mg/L (P for trend <.001). After additional adjustment for smoking, body mass index, diabetes mellitus, systolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, statin use, and antihypertensive treatment, a baseline CRP of 3.0 to 10.0 mg/L remained associated with risk of CHD (HR=1.87, 95% CI=1.09-3.25), although CRP did not improve the discriminative ability of a predicting model based on traditional risk factors (receiver operating characteristic curves from 0.740 to 0.749).
CRP is an independent CHD risk marker but does not improve CHD risk prediction in community-dwelling elderly people.
评估社区老年人全身 C 反应蛋白 (CRP) 与冠心病 (CHD) 事件之间的相关性。
一项基于人群的法国多中心前瞻性队列研究。
法国三个城市：西南部的波尔多、东北部的第戎和东南部的蒙彼利埃。
经过 4 年的随访，设计了一项病例-队列研究，该研究包括 9294 名基线时无 CHD 的初始队列中随机选择的 1004 名受试者和 174 名在随访期间发生首次 CHD 事件的受试者。
使用 Cox 比例风险模型估计风险比 (HR)，该模型适用于病例-队列设计，以 CRP 水平低于 1mg/L 作为参考类别。
在随机样本中，24.3%的 CRP 水平低于 1.0mg/L，45.8%的 CRP 水平为 1.0-2.9mg/L，29.9%的 CRP 水平为 3.0-10.0mg/L。经年龄、性别和研究中心调整后，CRP 为 1.0-2.9mg/L 时 CHD 的 HR 为 1.69(95%置信区间[CI]：1.04-2.75)，CRP 为 3.0-10.0mg/L 时 HR 为 2.32(95%CI：1.41-3.82)(P<0.001)。在校正吸烟、体重指数、糖尿病、收缩压、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、他汀类药物使用和降压治疗后，基线 CRP 为 3.0-10.0mg/L 仍然与 CHD 风险相关(HR=1.87，95%CI=1.09-3.25)，尽管 CRP 并未提高基于传统危险因素的预测模型的区分能力(受试者工作特征曲线从 0.740 到 0.749)。
CRP 是 CHD 的独立风险标志物，但不能提高社区老年人 CHD 的风险预测能力。
